If you are dreaming about becoming pregnant, calculate the cost of prenatal care, labor and delivery before you make a decision. Unfortunately, the cost of care is somewhat of a nightmare. Add to that the possibility of either you or the baby needing additional medical care, which helps prioritize the importance of health care coverage.
Significance
According to the American Pregnancy Association, over 41 million Americans are uninsured today. And of that number, even more are under insured . This means approximately 13 percent of pregnant women who deliver in the United States do so without any type of financial assistance. Unfortunately, this results in many women who can not afford the prenatal health care they really need. The estimated cost of a normal delivery alone is between $6,000 to $8,000 dollars, depending on where you deliver. If you have a complicated delivery, the cost can soar well beyond these figures.
Considerations
If you are considering pregnancy and you are insured, be sure to read your benefit coverage summary to understand whether or not you have access to maternity health care benefits. Mandated maternity coverage is not a federal law yet, but things are changing. Some states do have laws that apply to benefits in group insurance plans, and others are enacting new laws that mandate coverage for individual plans as well. Because some insurers consider pregnancy a pre-existing condition, if you are pregnant, it is generally not the best time to switch to a new insurance plan unless you can find one that does not have a pre-existing exclusion for pregnancy. If you have any questions, call your member services representative at your health plan for clarification.
It is also essential to understand that the individual health insurance coverage you have as a mother does not apply to your newborn baby. You will need to separately insure your baby to cover his health care costs. If you are insured, talk with member services to get the specific requirements for your plan. If you are uninsured, speak with a social worker at the hospital where to intend to deliver. They can help you evaluate your coverage options.
Private Individual Coverage
If you choose to purchase individual health insurance, you will need to add maternity coverage as an optional benefit. This is called a rider and will be more costly than if you were enrolled in a group plan with maternity benefits. Some individual plans have a 12-month waiting period prior to being able to access maternity coverage so read the description of benefits documents carefully. On the plus side, when you choose to purchase individual coverage, you will have the ability to choose the coverage you want to include.
Government Individual Coverage
Medicaid is a state and federally funded health insurance plan for individuals and low-income families. Medicaid rules can vary from state to state, but they do not consider pregnancy a pre-existing condition. The official title of the government entity that runs Medicaid is the Centers for Medicare and Medicaid Services, or CMS. Their website contains information that can help you locate an office near you. Plus, they have educational information regarding the plan, costs, eligibility and benefits. Your health care provider may also be able to provide information about Medicaid in your state. Another option is to call your local hospital and speak with a social worker who can help you understand the requirements and even help you complete the necessary paperwork to apply.
Health Care Reform
The national health care reform leaders are working on modifying the current rules. The reform plan does contain some changes with regard to access to maternity coverage in individual plans. According to the report created by Governor Ritter of Colorado, the plan includes HB 10-1021, "Required Maternity Coverage in Individual Insurance Policies". This bill requires that companies who issue individual health care insurance in the state must offer the same coverage for maternity care on par with the current offerings for sickness benefits. Coverage is mandated for pregnancy management including contraceptive counseling, drugs and devices in the state of Colorado. Check with your state's representatives to learn what is mandated and when it will take effect.
Member Comments