Having a baby is expensive. Really expensive.
One study suggests the average American hospital charges just over $32,000 for an "uncomplicated vaginal birth." And they charge almost twice that amount — nearly $52,000 — for a standard caesarean section, or C-section.
As if those figures aren't shocking enough, consider this: they're old. The study they came from was published back in 2013. Pregnancy costs surely have risen in the five years since.
Also, both figures are associated with straightforward births. Add a complication or two into the mix and the cost of a pregnancy can and will skyrocket. The same is true if you give birth to more than one baby at a time or if you have even a single child in some sort of non-hospital setting.
In other words, it isn't unusual for even a fairly typical birth to run up a tab that totals well over a hundred thousand dollars.
Thankfully, health insurance covers a lot of pregnancy and birth costs. Not all of them, but a lot of them.
But what if you don't have health insurance? Now is the time to get it — whether you've yet to become pregnant, you recently learned of your pregnancy or you're well on your way to delivering your little bundle of joy.
Now is also the time to read this article, which answers the following important questions about pregnancy and health insurance:
- How can I get health insurance from an employer while pregnant?
- How can I get health insurance through a spouse during pregnancy?
- How can I get health insurance from an Obamacare plan before I get pregnant?
- How do I calculate out-of-pocket health insurance costs while pregnant?
- How can I get to know a health plan’s network during pregnancy?
How can pregnant women get health insurance coverage?
There are a number of ways you can buy a health plan before or even after you become pregnant.
It used to be a lot more challenging to find coverage — affordable coverage, especially — after becoming pregnant. That's because insurance companies considered pregnancy a pre-existing condition. As a result, they either refused to cover pregnant women or charged them higher rates.
This is no longer the case thanks to the passage of the Affordable Care Act (ACA). The ACA, or Obamacare, opened the door for pregnant women, as well as Americans in all sorts of other situations, to more easily obtain health insurance.
Specifically, pregnant women — or women planning to become pregnant — now can get health insurance coverage through:
- An employer.
- A spouse who has job-based coverage.
- A parent, if you're still under the age of 26.
- The health insurance marketplace.
- An insurance company directly.
Keep reading to learn more about how these types of health plans differ from each other and how you can enroll in them.
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How to get health insurance from an employer
It wasn't so long ago that job-based plans were the best bet for anyone, pregnant or not, looking for health insurance. Employers usually paid a portion, and sometimes even all, of the premium. They often covered spouses and children at a reasonable cost (if not for free) as well. On top of that, employer-sponsored health insurance plans typically provided an ample amount of coverage.
Many of those things are no longer true for this kind of health plan. Thanks to rising costs and other economic realities, more and more employers have stopped being so generous with their insurance offerings. Some pay a smaller percentage of their employees' premiums. Some have stopped contributing anything at all in that area. Some continue to cover their employees' premiums but no longer assist with covering spouses or children.
Still, if a job-based health insurance plan is an option for you, seriously consider it before enrolling in another type of plan. If your employer's offering seems prohibitively expensive, though, or if you think the coverage is lacking, look elsewhere.
Just know that you'll probably have to wait for the next open enrollment period to come around if you want to buy a plan through your state's Obamacare marketplace or directly from an insurance company. You can qualify for Medicaid or Children’s Health Insurance Program (CHIP) coverage at any time of the year, though, so don't drag your feet in contacting your local agency if you think it's any kind of possibility.
How to get health insurance coverage through a spouse
Getting health insurance through a spouse is another great option if you're pregnant, or you're planning to become pregnant, and they have an employer-sponsored plan that'll cover you.
The questions you should answer before getting health coverage through a spouse, though, include:
- How much will you have to pay per month to be added to your spouse's plan?
- Will it provide all the coverage you'll need during your pregnancy? (You may have to talk with someone at the insurance company before you're clear on this one. In advance of that chat, though, read our article about how health insurance covers pregnancy.)
- What about copays and co-insurance? How much could they cost you throughout your pregnancy?
- How will this plan cover your newborn? And how much might that cost you and your spouse?
If you're happy with the answers you receive to those questions, go ahead and join your spouse's health insurance plan. If you're not happy with those answers, though, weigh your options. A plan bought through your state's ACA or Obamacare marketplace may be a better bet. Or you might find that buying a plan directly from an insurance company provides the best coverage for the best price.
And, again, don't forget about Medicaid. Should you qualify for it, it could provide you with the best coverage for the best price of all the options discussed here.
To learn more about this topic, check out our article about picking the right plan when both spouses have employer-sponsored health insurance.
How to get health insurance through a parent
Are you under the age of 26? If you don't currently have health insurance, but you have a parent who does, see if you can be added to their plan.
If your parent’s health insurance plan covers dependents, it should cover you — and you should be able to stay on it until you turn 26.
This is true of job-based health plans as well as those bought from a state marketplace or from an insurer directly.
As is pretty much always the case with these kinds of things, you'll likely have to wait for the next open enrollment period to come around before you can join a parent's health plan. That is, unless you qualify for a special enrollment period. For this to happen, you must go through a "life event" like losing health coverage, moving, or getting married.
Curiously, adopting a child and even having a baby makes you eligible for a special enrollment period, but becoming pregnant does not.
Other than that, all of the advice shared regarding the coverage options explained above is applicable here, too. Basically, thoroughly review and check out this kind of coverage before you sign on the dotted line.
Should you decide to get health insurance coverage through a parent, know that you'll have to find your own coverage once you turn 26. You won't have to do this the day that happens, thankfully; your parent's plan should cover you until Dec. 31 of that same year.
How to get health insurance from an Obamacare plan
The best thing about buying a health insurance plan through your state's Obamacare marketplace: everybody can do it. Assuming the timing is right, of course. In other words, assuming you do it during the yearly open enrollment period. Or you qualify for a special enrollment period.
If the planets align in that way, though, you may be in luck. Many marketplace plans provide a lot of maternity and childbirth coverage for a reasonable price. That can especially be the case if you choose a plan in the right "metal" category. For example, if you go with a "silver" plan and you qualify for discounts in the form of cost-saving reductions, you could save hundreds or even thousands of dollars each year.
One bonus of at least checking out the online Obamacare marketplace if you’re pregnant or you’re planning to become pregnant: when you apply for a plan there, it'll let you know if you're eligible for the discounts discussed above. It'll also tell you if you're eligible for Medicaid or CHIP coverage.
As mentioned earlier, becoming pregnant doesn't qualify you for a special enrollment period, so plan ahead for that, if possible. Actually having your baby does qualify you for it, however. Even better, when you enroll in a marketplace plan in advance of your delivery, you can make sure the coverage is effective the day your newborn enters the world.
How to get health insurance from an off-marketplace plan
Marketplace plans tend to be better bets than off-marketplace plans — plans bought directly from insurance companies — for most pregnant women or women planning to become pregnant. That's because you can't benefit from cost-saving reductions if you buy health insurance from an insurer.
Don't take that to mean you shouldn't even consider getting health insurance coverage directly from an insurer while pregnant. It's not impossible you'll be able to find an off-marketplace plan that provides better coverage or costs less than a comparable marketplace offering.
On a related note, if your state's ACA marketplace has a limited selection, you'd be a fool not to see what you could get from an insurance company directly. At worst, you'll waste a bit of time. At best, you'll find one or more plans that better fit your health insurance needs and wants.
How to get health insurance coverage from Medicaid or CHIP
Would you believe that Medicaid finances or supports nearly half of all U.S. births?
Well, it's true. Or at least it was back in 2010, which is the last time the Kaiser Family Foundation reported on the situation.
Those numbers probably aren't much different today. Even if they are, it's still likely a large percentage of American women rely on Medicaid while pregnant.
Given that, here’s what you need to know about getting health insurance from Medicaid or CHIP when you’re pregnant or planning to become pregnant:
- In general, your yearly income has to fall below a certain level to qualify for Medicaid. The same is true of CHIP, which provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.
- You don't have to be a math whiz to figure out if you're eligible for either of these programs. If you go to healthcare.gov and try to enroll in a plan, it'll let you know whether or not you qualify for them.
- Another option is to contact your local Medicaid or CHIP agencies. Someone there can tell you if you qualify for coverage while pregnant, what it means if you do, and more.
- You don't have to worry about enrollment periods when it comes to Medicaid or CHIP coverage. You can enroll in them, and receive coverage from them, any time of year.
How to calculate your out-of-pocket health insurance costs during pregnancy
There’s more to picking the best health insurance plan for you and your pregnancy than deciding where to get coverage. You also need to figure out how much you'll pay out of pocket for the plans you're considering.
To calculate what you’ll pay out of pocket for health insurance during your pregnancy, you've got to know how a particular plan deals with each of the following:
This is what you pay per month to maintain or access your health insurance plan.
This is how much you pay before your plan kicks in and covers some or all of the rest of your healthcare costs.
Copayment or Copay
This is the set amount you pay for specific services (such as doctor visits), treatments or medications under your health insurance plan.
This is what you pay for covered services and treatments. Usually it's a percentage rather than a set or fixed amount.
Also worth noting here is that health insurance plans often tie copays and co-insurance costs to out-of-pocket maximums. What that means is some plans only make you pay co-insurance costs until you reach a certain amount. Or they'll only charge you copays until you reach a certain amount.
Considering the above:
- Look closely at a health plan's copayments and co-insurance costs before you settle on one.
- Look closely at a plan's premiums and deductibles, too. Don't just pick the one with the lowest premium or the lowest deductible. In most cases, plans with low premiums have high deductibles. And plans with low deductibles often have high premiums.
Have peace of mind during your pregnancy by comparing health insurance plans
How to get to know a health plan's network while pregnant
Something else you should carefully consider when shopping for health insurance while pregnant is whether a plan is associated with a network of care providers like physicians, hospitals and labs.
If one is, such as if you’re considering an HMO or a PPO plan, take notice. Getting care from an in-network provider usually costs less — sometimes a lot less — than getting it outside the network.
Perhaps more importantly, don't be surprised if you receive some larger-than-expected bills if you make a habit of seeing out-of-network physicians or specialists.
This is an issue a lot of women have to deal with during and after their pregnancies. Why? It's not always easy to know which care providers are in your plan's network or not, especially once you're admitted to the hospital to deliver your baby.
As such, if your coverage is tied to a network, do your best to stay on top of who is and isn't part of that network. This will go a long way toward helping you avoid those "surprise bills" so many mothers and parents talk about after they've welcomed their newborns into the world.
And if you don’t yet have health insurance that will cover your pregnancy, do your homework and research which type of health plan is right for you before buying one.
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