Health insurance is a tricky subject. U.S. insurance companies vary greatly on what benefits they offer — and even two policies within the same company may be completely different, based on what employer is offering them. Even if you have maternity coverage (some policies exclude maternity or require a waiting period), find out as soon as you can what it means for your pocketbook.
You may have an insurance packet issued to you when you or your husband are hired at a new job — or, as many companies are doing, you may be given an internet link to look at the file online. As you peruse your policy, first determine if insurance coverage is provided for pregnancy. It will often be a separate section within the policy, and should clearly outline exactly what you should expect to pay throughout the course of your pregnancy, through the birth of your child and your postpartum checkup.
Co-pays are a fixed amount that is paid during certain circumstances. For some, a regular doctor’s visit may have a $25 co-pay. The structure may be different, however, for a pregnancy. For example, instead of a co-pay for each of your many prenatal appointments, you may just pay a single fee the first time you go.
Don’t forget to find out if there is a separate co-pay for a hospital stay. Many moms we spoke to reported that they not only had a co-pay for office visits, which included the birth, but there was another co-pay for the hospital stay itself — some in the $200 to $400 a day range.
Many insurance policies feature a deductible — a dollar amount the insured is required to pay per year, before coverage kicks in. The amount varies as widely as do insurance policies — moms we talked to reported a number of different deductibles from $500 to $1,000, and sometimes more. Some insurance policies don’t utilize deductibles at all.
Co-insurance is another aspect that needs to be determined when checking out maternity insurance coverage. Co-insurance is often a fee that comes into play once your deductible is met.
For example, if you have a $500 per year deductible, perhaps after that your insurance will pay 80 percent up to a certain dollar amount. Your co-insurance, then, is 20 percent.
Finally, many insurance policies have an out-of-pocket maximum built in, so you will only pay up to a certain price — after which the insurance company will cover 100 percent of the costs and fees. This dollar amount will be in the $1,000 to $3,000 range (if not more, depending on policy), and there is often a per person and per family max as well.
Keep in mind that not every policy has a deductible, co-pays or co-insurance. Some are simpler for parents-to-be to understand and far easier on the pocketbook. "We have a $25 co-pay for first visit, and everything else is covered 100 percent," shared Stacy, who is expecting her third child. "I will add that when I say 'everything else,' I mean all standard testing, ultrasounds, office visits, birth, after care, etc.. If I were to request something extra, I would be responsible for it."
Generally, your physician’s office will let you know up front what you can expect to pay during your first visit or two. They will verify coverage with your insurance company and will calculate your costs based on a normal vaginal delivery. They can also estimate costs for a twin delivery or a C-section. They can also let you know if they will be expecting payment up front or if they will be billing you on a monthly basis. If you’d rather find out prior to your pregnancy, you can phone your insurance company and a representative should be able to give you a clearer picture.
Even if you don’t plan on having a baby within the first year or two of a new job, it’s recommended that you don’t wait to find out until it’s too late what is and what isn’t covered. Shelly, mother of two, told us that her good friend’s wife is expecting a baby, but unfortunately there is no maternity coverage on their policy — at all. “He's spending the entire pregnancy stressed out over money and trying to hide that stress from her so she can enjoy her pregnancy,” she said.
Even if you have good health insurance, you may be surprised to find out that home birth, for example, isn’t covered. Often, birth assistants (doulas) and chiropractic care are also not included. And even state health insurance programs, such as Medicaid, may not cover some aspects of pregnancy and birth — such as routine circumcision of male babies.
Pregnancy is a joyous time, but can be made more unpleasant if you’re faced with unexpected expenses. Finding out what you will be forking over in advance, and having a plan in place to take care of your expenses, can help reduce stress and help keep your pregnancy cheerful.
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