Tag Archives: affordable care act

Health Care Coverage for Pregnancy and Birth

Having a baby can be expensive, and different kinds of maternity care have different costs. In the United States, a licensed midwife may charge as little as $3000 for prenatal care and attendance at an uncomplicated home birth. Using a midwife for prenatal care and a birth center for the birth may cost $4,000 to $5,000. (Note: These estimates don’t include the costs of prenatal tests, such as ultrasound scans and blood tests.) Using an obstetrician for prenatal care, having prenatal tests and having an uncomplicated vaginal birth in a hospital yields average charges of $30,000. A complicated cesarean birth can increase that cost to more than $50,000.. (Source.) Most health insurance plans are required to cover the basic costs for maternity care, but the details of what each plan covers varies.

The Affordable Care Act requires all Americans to obtain basic health insurance or pay a tax. Expectant parents (or those planning a pregnancy) have five main options for obtaining health insurance:

  • Through their employer. They can get this coverage even if they are already pregnant, and they won’t pay more than 9.5% of their income towards coverage.
  • Through their spouse’s employer. They should check costs carefully. It might be cheaper  to choose another option.
  • Through their parents’ insurance, if they are under 26 year old. They should check to see if the plan covers pregnancy for a dependent, as about 70% do NOT.
  • Individual coverage from a state exchange. They can go to the Marketplace at healthcare.gov or call 1-800-318-2596 to check their eligibility and compare their options. Lower middle-income families may qualify for tax credits, lower deductibles, or subsidies to help pay the insurance premiums. They must enroll during the open enrollment period, which lasts from November 15 through February 15 of each year.If they got pregnant after this period, they will not be able to get health insurance for that calendar year through the exchange.
  • Medicaid or CHIP – the Children’s Health Insurance Program for low income families. Expectant parents can apply for these at any time, via healthcare.gov or through their state’s agency directly. Note: Medicaid recipients may not have as much choice about caregiver and hospital. Because Medicaid does not reimburse providers as fully as private insurance companies to, many providers accept only a limited number of Medicaid clients, or none at all.

If they’re shopping for insurance options, they can ask each company for a copy of their “Summary of Benefits and Coverage” and look on page 7 in the “Having a Baby” section to learn what common costs are paid by the insurance and what deductibles and co-pays they may be responsible for.

Whether they’re researching existing health insurance or choosing a new plan, they should also look at the detailed information about what care is covered. Visit our web site, http://www.PCNGuide.com, to download a work sheet of questions to research. If they don’t understand the extent of their coverage, contact an insurance company representative for clarification. That way, if they decide to have an uncovered or partially covered service, they’ll know how much they’ll pay out of pocket.

Some insurance plans cover—but don’t directly pay for—such services as midwifery care, childbirth preparation classes, birth or postpartum doulas, home birth, and breastfeeding assistance. Instead, parents pay for these services and the insurance company reimburses them.

Parents may also use a flexible spending account (FSA) or health savings account (HSA) to pay for uncovered or partially covered services. Both accounts allow someone to set aside money before paying taxes on it, to use for qualified medical expenses. FSAs are employer-established benefit plans. HSAs are available for employees or individuals with high-deductible insurance policies..

When the baby is born, a parent can choose to add the baby to their existing health insurance, or they can apply for new insurance through the health exchange, even if it’s outside the normal time frame for open enrollment.