Another child on the way is often a time for celebration, but for most couples this blessing comes with additional responsibilities. Foremost among these is choosing a health plan that not only provides access to top-notch medical care that ensures the health of mother and child, but also offers robust financial security in the face of mounting medical expenses. The right health insurance policy may mean the difference between a joyous celebration for your new arrival or nerve-wracking anxiety about thousands of dollars in bills.
If you are uninsured, you could pay from $30,000 to $50,000 for a pregnancy, and that doesn’t include thousands more you will probably need for prenatal and newborn care. If there are any complications during the pregnancy or birth, you could easily pay more than $100,000. Needless to say, you want the most financial protection possible to prepare for any potential contingency.
How the Affordable Care Act Improved Health Plans for Mothers
Prior to 2014, most health plans didn’t include coverage for pregnancy, childbirth or newborn infant care. You had to purchase a plan that specifically included maternity care or an additional rider to your existing plan that covered these services. Because pregnancy was considered a pre-existing condition, insurers could deny you a policy or charge you more.
However, when Congress passed the Affordable Care Act (ACA), that all changed. The ACA made sure that all full-term health insurance policies included maternity care. This included
- Prenatal physician visits
- Postnatal checkups
- Gestational diabetes screenings
- Lab tests
- Newborn care
- Lactation counseling
- Breast pump rental
Since then, if you purchased a health plan prior to knowing you were pregnant, you can rest easier in the knowledge that policy includes maternity care. If you know you are pregnant and are shopping for health coverage, you can take comfort in the fact that insurers can no longer deny you a policy or charge you more due to your pre-existing condition. However, if you want to enroll in an ACA-sponsored health plan, you must do so during the annual Open Enrollment Period.
If you are pregnant and without health insurance, then the first place to look for coverage is Medicaid. Although the government insurance program Medicaid is primarily for low-income families, it does make some exceptions for pregnant women. Generally, if you make less than 133 percent of the federal poverty level, you are eligible to enroll in your state’s Medicaid program, but you should check with your state Medicaid office since every state has its own set of eligibility criteria. Even if you applied to enroll in Medicaid before and were rejected, you may be eligible as a pregnant mother.
If you are accepted into Medicaid, then you will enjoy many coverage benefits. This means you will be able to obtain care from a Medicaid-authorized provider that is related to prenatal, delivery and complications. Furthermore, you get up to 60 days of care following your delivery. When you enroll in Medicaid, you will be sent a list of providers in your area that accept Medicaid. If you get care through this Medicaid provider, all of your pregnancy related expenses will be submitted to the agency so that Medicaid can reimburse them.
If you apply for Medicaid as a pregnant mother, you will be given priority consideration; this expedited decision process should produce a response within two to four weeks. Some states even provide Presumptive Eligibility which reimburses you or your doctor for expenses incurred for prenatal care prior to your enrollment.
If you do not qualify for Medicaid, then you should consider obtaining health coverage through one of the health plans sponsored by the Affordable Care Act, commonly known as Obamacare. You may find one of these plans on the federal or state health insurance marketplaces serving your region. You may learn more about these plans by visiting Healthcare.gov or a trusted insurance agent or broker like Boost Health Insurance.
Obamacare health plans are available in four tiers: Bronze, Silver, Gold or Platinum. Each tier has a different amount of coverage (i.e. pays a larger percentage of medical expenses) in return for a higher or lower monthly premium. However, you may only need to pay a small fraction of this premium—or possibly nothing at all—if you qualify for federal tax subsidies. If you make between 133 and 400 percent of the federal poverty level, you could pay hundreds of dollars less in premiums every month.
Private Maternity Insurance
Private maternity insurance is often a great way to protect your finances while still retaining access to high quality medical care before, during and after delivery. You can find insurance policies in a variety of places including Healthcare.gov, local insurance agent or broker. You should keep in mind that insurance agents work for insurers so they may only offer policies from one company. On the other hand, government agencies and insurance brokers are more independent, so they are likely to provide a greater selection of policies from multiple companies.
While you are shopping for a maternity policy, you should generally look for a higher premium policy with a low annual deductible. As you know, a pregnancy will cost many thousands of dollars, so you want a policy that will cover as much of that cost as possible. You may pay more in monthly premiums, but a lower annual deductible means your insurer will be responsible for a larger portion of medical bills.
Also be sure to examine closely your policy’s network. If you already have a physician, make sure they and their affiliated hospital are in-network. Otherwise, you could be paying much more or all of your medical expenses because you incurred out-of-network charges. Also make sure that your local emergency room is in your network in case you experience an unexpected delivery.
To learn more about maternity insurance policies available in your area, please visit Boost Health Insurance.