Comment by Aaronontheweb

Comment by Aaronontheweb 2 days ago

23 replies

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> Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies

I am absolutely not eligible. I earn more than $150k. And "manipulating your income" is not really feasible with a pass-through entity.

> The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.

As I mention in the piece, I check every year. I have no idea what subsidized plans include, but the other marketplace plans definitely do not include child birth.

I explicitly address this point:

> The Affordable Care Act (Obamacare) barred insurers from turning down applicants based on existing pre-conditions; the way insurers get around this for pregnancy and child-birth is not by rejecting pregnant applicants (illegal), but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)

and

> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those. All of the ones I’ve found through eHealth Insurance or Healthcare.gov never cover it - and I check every year.

Love the over-confidence though. The best outcome for me in even writing this article would be to get some internet commenter pissed off enough to find me a cheaper version of my plan. That would solve my problem immediately!

codingdave 2 days ago

ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...). But it might not matter because you aren't on a marketplace plan according to the screenshots in your post.

You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf

Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max, so the childbirth should top out at the 7150. Other expenses might put you at the same 40K cost for the year, but not the childbirth alone.

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  • Aaronontheweb 2 days ago

    > the $14300 is the family out of pocket max

    You know they charge you, separately, for both the mother's care AND the infant's during a delivery right? Those count as two people. I am, with 100% certainty, going to hit the out of pocket max - I have every time.

    Like I've paid for three kids all on the same plan, including one born in January so my deductible got spread over two different billing years.

    I have to ask - why are you defending this?

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    • codingdave 2 days ago

      I'm not defending it. I'm correcting your misinformation. You are claiming that ACA plans do not cover childbirth. They do. You are claiming that this event alone costs 40K, which is not accurate. It hits your out of pocket max, exactly as designed.

      It sounds like you have never looked at an ACA silver plan, which is the lower deductible/out of pocket max option. I also have a family of 5, and have a $1800 per year out of pocket max from an ACA plan. You would still have the same level of premiums as you do now for silver plans, but you would save 13K a year. You are picking bad plans, dude.

      Our system has problems, but when you make enough to not be subsidized, yet still pick a crappy 40K per year plan, that is beyond the systemic problems. It is a bad choice. There are insurance consultants who work with people, especially high income people, to find good plans for their family. You should be calling them.

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      • Aaronontheweb 2 days ago

        Dude, you don't even have your own facts straight and you are embarrassing yourself. It's clear you have no experience, don't understand your own sources you provided, or any clue how child birth actually works from a medical billing standpoint.

        Edit: what do I have to gain from spreading "misinformation?" I just want better / more options?

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bonsai_spool 2 days ago

> And "manipulating your income" is not really feasible with a pass-through entity.

I don't know if you have a CPA, but this is a sentence my CPA has never uttered.

> but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)

Including...? I have never heard of this, and actually have delivered babies and worked with post-partum mothers.

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  • Aaronontheweb 2 days ago

    The explanation of benefits simply doesn't cover child birth - this is extremely common for individual marketplace plans.

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    • tptacek 2 days ago

      If by "individual marketplace" you mean the Healthcare.gov-style ACA individual marketplace, you now know this to be totally false.

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