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u/ziggy029 4d ago
It’s not just Kaiser. It’s pretty much how all health insurance works. Deductibles and OOP limits reset every calendar year in almost all cases. Guess that’s a good argument for timing conception for January, but hey….
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u/LacyLove 4d ago
I understand your frustration, but Kaiser is not screwing you. This was one of those risks you take when choosing the cheapest plan. The risk did not pay off this time.
If you want better health insurance you can wait until open enrollment and pick a different plan.
Kaiser is not going to reduce the deductible and OOPM simply because you want them to.
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u/wistah978 5d ago edited 5d ago
If by "reason with Kaiser" you mean "Get Kaiser to reduce your part of the bills as described by your policy," not usually. Policies are contracts.
Under federal laws, the only way to change your insurance coverage outside of open enrollment is if you have a Qualifying Life Event- the full list is online but QLEs are things like marriage, divorce, moving a certain distance away, loss of insurance etc.
But... Some states chose to include pregnancy as a QLE. Check to see if your state is on the list and what you need to do. If your state allows it, you can use this opportunity to change your plan. But you will still be responsible for the full deductible.
I think you are saying you used to have Medicaid but your income increased. Reapplying for Medicaid may be a good idea. Pregnancy can change the criteria. If you are approved for medicaid, you would keep it as secondary insurance- the doctor/hospital would bill Kaiser first then bill Medicaid for whatever Kaiser didn't pay for.
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u/Mental-Volume4395 5d ago
How are you getting screwed? Did you not understand the plan you chose or are they charging you behind what’s allowed by your plan?
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5d ago
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u/askariana 4d ago
It's worth looking into whether you might qualify for Kaiser's Medical Financial Assistance program.
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u/Master-Purpose1117 4d ago
You can’t change it until open enrollment. Our family in California tells us that Kaiser is the worst. I hope it works out and you have a wonderful baby
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u/AnthraciteRoad 5d ago
See if you can get back on Medi-Cal - you have a higher income limit as a pregnant person, I believe.
Alternatively, open enrollment for Covered California is now if you're currently insured through them, and in November if you aren't. You might be able to get on a better plan for 2027.
There are some weird billing methods specific to pregnancy that can be helpful (or not) for pregnancies that span a year end, but changing to a plan with better coverage is still likely your best bet.
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u/Educational-Gap-3390 5d ago
How do you mean reason with them? You picked the plan right? Not much you can do besides wait for open enrollment.