Pregnancy Health Insurance Coverage

Health insurance coverage for pregnancy care varies based on the type of plan. Possibilities range from the more comprehensive coverage of a group health insurance plan to federally funded Medicaid coverage. It is important to explore the specifics of your health insurance coverage for maternity care to avoid unexpected expenses.

Group Insurance Plan

A company that employs 15 or more individuals is required by federal law to offer an insurance plan that covers medical expenses related to pregnancy. Group insurance plans typically offer the best coverage. It is important to verify the specific coverages of your group insurance plan. You should also understand your financial responsibility toward the medical bills that will not be covered by the group insurance plan.
A group insurance plan typically covers all of the maternity expenses including your regular visits with the obstetrician, the hospital expenses, doctor’s fees and medications needed. You will likely be responsible for a portion of these bills through copays, deductibles or coinsurance. Your portion may be a set dollar amount or a percentage of the total bill. The baby is generally afforded coverage by the insurance plan after birth. Your group insurance plan may require you to notify them before the baby is born. You will also need to verify the birth to have your child officially added to the group health insurance plan.

Individual Insurance Plan

An individual health insurance plan is one that a family purchases through an insurance agent or directly from an insurance company. Coverage on an individual health insurance plan varies. Many individual health insurance plans exclude pregnancy except for complications. An individual plan that includes maternity coverage will carry a higher premium. When selecting an individual insurance plan, the coverage offered for maternity care should be analyzed. The coinsurance and deductible for the maternity coverage may differ from coverage for other medical conditions. Some maternity services may not be covered. Verify the coverage for services such as prenatal care, ultrasounds, birth defect testing, hospital fees and epidurals.

Medicaid

Medicaid is an option for women without other health insurance coverage. A pregnant woman must meet eligibility requirements to qualify for maternity coverage under Medicaid. Medicaid is not accepted by all health care providers so it is important to verify acceptance before scheduling a prenatal appointment. The health care provider will generally submit all billings to Medicaid for payment. A pregnant woman on Medicaid may be required to pay a small copay for maternity coverage. Coverage and qualifications for Medicaid vary by state. After the baby is born, he will also be covered by Medicaid.

Health Care Discount Programs

Programs offering a discount on health care expenses are an alternative to traditional health insurance plans. These plans charge a monthly fee in exchange for discounts on health services. Programs such as Maternity Advantage offer services targeted for pregnant women. Participants typically receive a discount of a certain percentage when obtaining health care services from approved providers. Women who are already pregnant generally qualify for these programs, unlike individual health care plans that may exclude pregnancy as a preexisting condition.

Considerations

Pregnancy coverage varies significantly depending on the health insurance plan. It is important to understand the amount and type of coverage afforded by your health insurance plan. Confirm the specific services covered such as prenatal care and screenings, doctor’s fees, hospital fees and epidurals. Ask if pre-authorization is necessary before the baby is born. Verify that your provider and preferred hospital are covered under the health insurance plan. Check on the deductible, coinsurance, copay and out of pocket maximum levels for the maternity coverage. It is important to know the amount of payment that will be your responsibility and when it is due. Verify the length of the hospital stay that the plan generally covers. Midwives and natural birthing centers are not covered by all health insurance plans so check with the company if this is your preferred course of prenatal care. Understanding the coverage provided by your health insurance plan will prevent unexpected expenses.