The medical costs for a standard, healthy pregnancy and delivery can be very high. Many women with private health insurance are shocked to find maternity is not covered under their policy. Here is what you need to know about pregnancy and health insurance.
Pregnancy can be an exciting and fulfilling time for parents. Hundreds, if not thousands of hours will be spent preparing for the birth of their child. Baby names will be discussed, baby products will be researched and purchased, the entire home will be baby proofed and of course many parenting books will be read. But there is one aspect of having a baby that too often goes overlooked. The medical costs of pregnancy and delivery are often not covered under many private health care plans.
To some it may come as a shock. It seems illogical that pregnancy wouldn’t be considered a medical condition. However, some health insurance providers rationalize that pregnancy is a normal and healthy part of being human. Additionally, pregnancy is not due to random chance like an illness or disease, and thus shouldn’t be covered under insurance.
Regardless of why it isn’t covered or whether or not it should be, medical coverage for pregnancy is something you need to be prepared for. For most people who have their medical insurance through an employer with more then 15 people, maternity coverage is required by the Pregnancy Discrimination Act. This does not, however, apply to individual plans which are growing in popularity. There are a dozen states that now require coverage be extended to pregnant women with private plans. For those in the other 38 states, there are often a few providers that will offer coverage under their health plans, though the premiums are generally higher.
If you think there is a possibility you may become pregnant and you have private insurance, make sure you have maternity coverage. If there is any doubt at all, call your provider and ask specifically what is covered. Even for those with plans that do cover pregnancy, the costs are likely subject to your deductible and coinsurance. Having coverage still may result in high out of pocket costs.
If your plan does not cover pregnancy, see if they offer a maternity rider. Maternity riders are policy add-ons that cover the costs of prenatal care and delivery. These are generally paid for with an extra monthly premium and often require a waiting period before you can get pregnant, some as long as 12 months. The cost for a maternity rider is often high and it is likely that with a long waiting period, you will wind up paying as much for the rider as you would for the pregnancy on your own.
Paying for prenatal care and delivery without insurance can be very expensive. If you go without coverage, contact several local hospitals and ask what they charge. The differences in costs can be dramatic. Also, consider switching to an insurance plan with a health savings account. The costs of pregnancy can be paid for out of your HSA, leading to significant income tax savings.
If you are already pregnant and discovered that you do not have insurance that covers pregnancy, it will be difficult to find a plan that does. Pregnancy is considered a pre-existing condition and will often result in a denied application. In such a case, check what the qualifications are to join your state’s high risk insurance pool. You may be able to gain coverage with reasonable premiums. Another option is the Pre-Existing Condition Insurance Plan offered by the Federal Government. The PCIP is designed for people who can not get coverage through the private market due to a pre-existing condition.
In 2014 due to the Affordable Care Act, all health care plans will be required to cover maternity and none will be able to deny coverage due to pre-existing conditions. But until those laws are put into place, make sure you have proper coverage.
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