How to Choose the Best Health Insurance Plan for Your Pregnancy
If you're going to have a baby, you need health insurance. But what kind of plan best covers all of the costs of pregnancy? And how can you get that coverage if you don't already have it? Here's all you need to know to get the best health plan for your pregnancy.
Having a baby is expensive. Really expensive.
And we're not just talking about the actual "giving birth" part of bringing a child into the world here, by the way--although that alone costs plenty of money.
How much money? One study suggests your 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 of those figures are associated with straightforward births. Add a complication or two into the mix and your own "baby bill" can and will skyrocket. The same is true if you give birth to more than one baby at a time (twins, triplets, you name it) 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. Toss all of the other costs tied to having a baby into the equation and the price goes even higher.
Granted, some of this depends on where you live and where you give birth. Giving birth in some states is more expensive than it is in others. And giving birth in some healthcare settings is more expensive than it is in others.
Thankfully, health insurance covers a lot of these costs. Not all of them, but a lot of them. (Don't be surprised if you're still on hook for a few thousand dollars after all is said and done.)
But what if you don't have coverage? Now's 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.
By the way, after you finish reading this article, and once you're ready to buy a plan, take a look at another of our articles: "Everything You Need to Know to Apply for Health Insurance."
Many Health Insurance Options for Pregnant Women
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, by the way. 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, which opened the door for pregnant women, as well as Americans in all sorts of other situations, to more easily obtain health insurance.
Specifically, they--and you--now can get it 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 plans differ from each other and how you can enroll in them.
Getting 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, and often covered spouses and children at a reasonable cost (if not for free) as well. On top of that, employer-sponsored 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 plan is an option for you, seriously consider it before going with 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 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.
Getting Coverage Through a Spouse
This is another great option if you're pregnant, or you're planning to become pregnant, and your spouse has an employer-sponsored plan that'll cover you.
The questions you should answer before taking advantage of it, 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, go through our article, "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 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 this related article: "Picking the Right Plan When Both Spouses Have Employer-Sponsored Health Insurance."
Getting Coverage 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 his or her plan.
If that 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 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 go this route, know that you'll have to find your own insurance once your 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.
Getting Coverage via a Marketplace Plan
The best thing about buying a plan through your state's health insurance 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. (See the last section for more information.)
If the planets align in that sort of 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 marketplace: 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.
Not sure which kind of marketplace plan might be best for you and your pregnancy? Read our article, "Which Type of Obamacare Plan is Right For You?"
Getting Coverage Through 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 this option. 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 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.
Getting 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. (For more information, read "Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey.")
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.
In general, your yearly income has to fall below a certain level to qualify for Medicaid. The same is true of CHIP. (If this is the first you're hearing of CHIP, it provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.)
Thankfully, 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, of course, is to contact your local Medicaid or CHIP agencies. Someone there can tell you if you qualify, what it means if you do, and more.
Oh, and 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.
Don't Forget to Calculate Your Out-of-Pocket Costs
The process of picking the best health insurance plan for your pregnancy doesn't end with you deciding where to get coverage.
Going hand in hand with that is figuring out how much you'll pay out of pocket for any of the plans you're considering.
To do that, you've got to know how a particular plan deals with each of the following:
Premium: This is what you pay per month to maintain or access your plan.
Deductible: 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.
Co-insurance: This is what you pay for covered services and treatments. Usually it's a percentage rather than a set or fixed amount.
On a related note, 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.
Given all of the above, it's important to look closely at a plan's copayments and co-insurance costs before you settle one.
It's also important to look closely at a plan's premiums and deductibles. 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.
For more on all of the above (and then some), check out the article, "How to Pick a Health Insurance Plan."
Get to Know a Plan's Network, Too
Something else you should carefully consider while shopping for health insurance as a pregnant woman (or woman planning to become pregnant): whether or not a plan is associated with a network of care providers like physicians, hospitals, and labs.
(These usually are called "managed care" plans and include everything from Health Maintenance Organizations, or HMOs, to Preferred Provider Organizations, or PPOs, and Point of Service, or POS, plans. Find out how they differ, and how they're similar, in this article of ours: "Which Type of Health Insurance Plan is Right for You?" You may want to read this article, too: "HMO vs. PPO: What Do Those Letters Mean?")
If one is, take notice. Getting care from an in-network provider usually costs less--sometimes a lot less--than getting it outside the network.
Or 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 it. That'll 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.
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