Maternity Insurance and the Cost of Pregnancy:Fact and Fiction
Pregnancy is one of the most exciting times in a woman's life. It can also be a trying time, especially with all the expenses associated with it. If you’re pregnant or planning on becoming pregnant, you may wonder if maternity insurance is worth it for you and your family.
In this post, we'll go over what maternity insurance is and how much it costs for mothers-to-be to purchase coverage for pregnancy complications such as gestational diabetes. We'll also talk about myths and facts related to maternity insurance claims and false pregnancy scams that are circulating the Internet.
What is Maternity Insurance?
Maternity insurance is a type of health insurance that covers health-related events associated with pregnancy. The Affordable Care Act requires all individual and small group health insurance plans to offer maternity coverage. For large employer plans, companies with more than 50 employees, they're not required to cover the cost of maternity insurance as part of their employee benefits, but most do anyway. Even though the Affordable Care Act has mandated maternity coverage in most individual and small group plans, there are some exceptions like short-term health insurance or limited-duration plans that don't have to cover it.
What Does Maternity Insurance Cover?
Maternity insurance covers a number of different pregnancy-related conditions and complications related to a woman's labor and delivery. There are out-of-pocket costs for these services as well as copayments or coinsurance, but if you have maternity insurance, most pregnancy related care will be covered after the deductible has been met. The following list includes common maternity insurance benefits:
One of the biggest myths about maternity policies is that they cover elective, or non-medically necessary, abortions. Maternity policies don't cover abortions since they're not considered a standard pregnancy complication like premature childbirth or gestational diabetes. Instead, women may have to purchase a separate abortion policy if they decide to terminate their pregnancy.
How Much Does Maternity Insurance Cost?
The cost of a maternity policy varies from one insurance company to another. Likewise, the cost also depends on the companies' plans such as one that's designed for healthy women or another for women with health issues where complications are more likely. Premiums can also vary based on your age and whether you smoke or use any type of tobacco products. Annual premiums for maternity insurance range from about $25 to over $1,000 depending on your age and health history. The average premium is about $200 a month per person.
What Are Some of the Features of Maternity Insurance?
Maternity insurance features vary by insurance company. Many policies will cover maternity care before and after your delivery so you can start taking care of yourself sooner as well as care for your new child. The following are some other benefits offered with some of the most popular maternity policies:
While the Affordable Care Act requires that all plans sold in the individual and small group markets offer maternity benefits, there are still a number of women with unique situations who may not be covered by their employer or don't work at a company large enough to offer employee benefits. For these women, maternity insurance may be a solution.
What are the Risks of Not Having Maternity Insurance?
There are some risks associated with not having maternity insurance when you're expecting. For example, if you have a pre-existing condition and get pregnant, it's likely that you won't be covered by your employer's health insurance plan or one of their partners. This could cost you thousands of dollars in out-of-pocket payments for medical diagnostic tests and visits to your doctor and hospital. There's also the possibility that you'll receive a denial from your insurer if they discover that the reason for your condition is because of pregnancy.
What are Some of the Risks of Private Maternity Insurance?
Just like any other type of insurance policy from life to home to auto, there are risks involved when you buy private maternity insurance. The biggest risk is if you have a medical condition and pregnancy makes it worse. For example, women who have gestational diabetes may need more medical care than normal during their pregnancy because they're at a higher risk for complications and having their baby prematurely. If your insurer doesn't cover gestational diabetes, you could be left with thousands in unpaid medical bills after giving birth.
You might also not be covered if your condition for pregnancy is considered pre-existing. Pre-existing conditions are medical problems or symptoms that you had before your pregnancy, but the symptoms worsened during your pregnancy. For example, women who have endometriosis may develop ovarian cysts during their pregnancy that could rupture and may cause some bleeding. If you have a history of endometriosis, you're at a higher risk for developing ovarian cysts so your insurer could refuse to cover the cost of this complication during your labor and delivery.
Some other pregnancy related conditions that are considered pre-existing conditions include gestational diabetes, high blood pressure, high cholesterol and certain autoimmune diseases like Lupus. If you're denied maternity insurance because of your pre-existing condition, you can sometimes be covered if you get pregnant while on the waiting list for coverage.
Another risk with private maternity insurance is if the policy is not paid up to date. It's common for policies update every year or two and while they may be up to date on your most recent policy, they may not cover you if your pregnancy occurred more than two years ago. If you had a recent pregnancy and you're looking to get maternity insurance, check with the company to make sure their policy is current. If not, you may have to look for a new provider.
What Are the Risks of Public Maternity Insurance?
While there are risks involved with private maternity insurance, public programs like Medicaid and CHIP are government funded programs that will cover you in most circumstances. Usually there are income requirements or family size limits that apply when enrolling in these types of plans so if you qualify for public assistance, you will need to apply on your own.
Some of the risks with public maternity insurance are due to the limitations of these budget programs. For example, Medicaid has strict guidelines on what types and how much medical care you can get and in some states, it's very limited. If you need a C-section or other advanced surgeries or medications, you may not be able to get them as part of your state's Medicaid benefit package. In some cases, surgery may be covered while a prescription won't be. You'll need to check with your state and federal programs to see what they cover to ensure your medical needs are met adequately during your pregnancy and delivery.
Most public maternity insurance plans don't have annual limits although there are some exceptions.
Conclusion
Having maternity insurance is a good idea for most women. You can depend on it to cover the usual medical costs during your pregnancy and delivery. It also comes in handy if you have a pre-existing condition or get pregnant after your policy has expired.
Maternity screening, just as with any other type of medical screening, should be performed as soon as possible. Some women who experience complications during their pregnancy have had problems that could have been prevented had they known something was going on earlier in their pregnancy.