Share This Article:

Do you have the right pregnancy insurance?

Maternity coverage and medical bills in health care reform

Let’s face it: pregnancy costs are more than most people can afford out-of-pocket. According to Healthcare Blue Book, the fair price for a normal vaginal delivery is $6,152. That includes the doctor, the hospital, and anesthesia services. That said, the government recently released national data on hospital pricing that illustrates pricing variations of 400% or more in health care.

We have certainly had clients tell us that they received bills for more than $20,000 for their normal pregnancy. Whether it costs $6,000 or $26,000, you need to know what your health insurance will cover, and how much it will cost.

If You Have Insurance Through an Employer

If you’re on a qualified employer group plan, either through your employer or your spouse’s, you probably have some maternity coverage. Even if you were pregnant before you joined the plan, you will have coverage as HIPAA does not allow carriers to consider pregnancy a pre-existing condition when it comes to group health plans. 

Now, just because maternity is covered by your plan, you’re still likely to have some out-of-pocket costs. Your out-of-pocket costs will vary based on your deductible, your out-of-pocket maximum, and copays. Check your Benefits Summary for this information or speak to your human resources department.

If You Have an Individual Policy

If you’re on an individual health insurance plan, it’s unlikely that any maternity costs related to normal delivery are covered. This means you will be responsible for the entire cost of the delivery. 

If you want to avoid this exposure, one option is to add a maternity rider to your plan. This will add to your monthly premiums, but it will mean that delivery expenses will count towards your deductible. It will also mean that you will receive the insurance company-discounted rate for your delivery expenses, versus having to negotiate yourself. 

When exploring this route, there are a few things to keep in mind. The first is that these riders generally have a waiting period before the maternity coverage kicks in of at least six months. This means if you get pregnant before that waiting period is over, your pregnancy will not be covered by insurance, and you will be back to being fully responsible for the costs. Check with your health insurance company for what coverage you currently have and details about adding a maternity rider. You can reach the customer service line by calling the number on the back of your insurance card.

If you decide to add a maternity rider or already have one on your plan, make sure you know your deductible, out-of-pocket maximum, and copays. This information will be in your health insurance policy, or you can call your insurance company.

What’s Changing with the Affordable Care Act?

The Affordable Care Act requires individual plans to cover what they're calling "Essential Health Benefits." Pregnancy is included in the definition of "Essential Health Benefits." This requirement goes into effect in 2014. If you purchased your policy after March 23, 2010, this requirement will go into affect for you on your policy’s 2014 anniversary date.

For example, if your policy’s effective date was July 1, 2011, then this will go into effect with your policy’s renewal on July 1, 2014. If you purchase a new health plan with an effective date of January 1, 2014 or later, then the policy you purchase can automatically cover pregnancy with no waiting period. Bear in mind that we anticipate there will be some policies out there that don’t comply with this part of health care reform, in which case this would not apply.

Still have questions?

We know this is an important topic for a lot of people. A lot of my clients who are thinking about having a baby have anxiety around this. With all of the changes around health care reform, anxiety levels are even higher than normal. So, at Bernard we’re writing a complete guide with more detail on how all of this stuff works, including more information related to how complications are covered. It will be available by the end of May. If you’d like a copy when it comes out, leave a message in the comments section below or check back with us later this month!

Get a free consultation

You might also like: Health insurance advice: Is pregnancy a qualifying event?

Image credit:

Share This Article:

Related Posts

From explanations of forms to 2020 deadlines - and everything in between - here's what...

Slightly increased contribution limits for 2020. Here's a breakdown of what you and...

Your organization may be eligible for a premium rebate The Affordable Care Act limits...

Most insurance companies cover the flu shot as preventive care Summer’s barely over,...

Submit a Comment