What You Need to Know About Maternity Insurance Coverage

Pregnancy can be very costly, and an uninsured pregnancy can cost tens of thousands of dollars out of pocket. If you are planning to get pregnant, you need to know about the ins and outs of maternity insurance coverage. It is important to not assume that your insurance plan covers pregnancy. Maternity insurance coverage typically refers to coverage for prenatal care, delivery, and postpartum care for both mother and baby.

Pregnancy Costs

The cost of pregnancy varies depending on where you live, the medical facility or hospital where you deliver your baby, and whether your pregnancy and delivery are normal. High-risk pregnancies, premature births, and other complications will likely increase costs.

Prenatal care involves regular visits to your OB-GYN, supplements such as prenatal vitamins, and diagnostic tests such as ultrasounds. During this time, your doctor will monitor both your health and the health of your growing baby. The average cost of prenatal care is about $2,000 if you do not have insurance.

If you choose to delivery your baby in a hospital, the expenses add up quickly. Government data shows that in 2008 an uncomplicated vaginal birth was about $9,600 while a cesarean section was about $15,800. According to the March of Dimes, the average cost for nine months of uncomplicated prenatal care, and three months of complication-free postpartum care is $10,652.

Maternity Insurance Coverage

Insurance Coverage

Health insurance plans that include maternity coverage will generally cover part or all pregnancy costs. The details of your policy’s maternity coverage differ from plan to plan. Medicaid or group health insurance plans normally cover all healthcare costs related to pregnancy.

Individual health plans are a different story. The Pregnancy Discrimination Act of 1978 states that maternity care coverage is required. However, this does not apply to companies with fewer than 15 employees or to individual policies. If you are pregnant and on an individual health insurance plan be aware that it is common for individual health insurance policies to exclude maternity care coverage. In 2009, the National Women’s Law Center found that 87% of individual health plans did not include maternity insurance coverage.

If your individual health policy does not cover maternity care, you may have the option of a special rider for the coverage. Although riders provide extra coverage, it is often limited and there may be a waiting period before the coverage kicks in. If you incur pregnancy-related expenses during that waiting period, you will have to pay those out of pocket.

If you lose her job while pregnant, you have the option to enroll in your former employer’s COBRA plan. Again, it is important to know your rights under COBRA as companies with less than 20 employees are not required by federal law to offer COBRA. If you change jobs while pregnant, your new employer’s health insurance plan may have a new employee eligibility period before coverage kicks in. A new employer is not required to cover pregnancy costs during the eligibility period. If you switch jobs during your pregnancy, you may be eligible for COBRA with your old employer.

Uninsured and Pregnant

Try not to wait until you are pregnant to purchase insurance coverage. An uninsured woman seeking individual health coverage will likely be denied because pregnancy is considered a pre-existing condition. Under the federal HIPAA law, pregnancy cannot be considered a pre-existing condition. However, this mainly applies to group plans not individual plans. On a positive note, there are some states that currently require insurance plans, including individual and small group plans, to include maternity benefits.

While it is best for a woman to have health insurance before she gets pregnant, many pregnancies are unintended. If you become pregnant and do not have healthcare coverage, consider applying for Medicaid. To apply for Medicaid while pregnant you will need proof of pregnancy, proof of citizenship, and proof of income. Even if you make more income than the federal poverty level, you may still be eligible. Contact your local Medicaid office for further details.

This was a Guest Post by Brenda Panin, a regular contributor to several blogs and a web content writer for iSelect. She writes about insurance and new business strategies.

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One Thought to “What You Need to Know About Maternity Insurance Coverage”

  1. In 2014 the essential health benefits mandated by the Affordable Care Act will require a level of coverage for prenatal care, and hospital admissions. The law provides for plan design levels and corresponding premium rates. Expect those with smaller deductibles to cost far more – an important component to those planning to use the program.

    Employee paid supplemental policies allow for maternity coverage with no waiting period, a reasonable middle ground for many families.

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