After the joy of learning about a pregnancy, cold reality can set in: Having a baby is expensive. According to the American Pregnancy Association, prenatal care and delivery costs can range from $5,000 to more than $20,000. Obviously, good health insurance can play an important part in managing these costs. To prepare yourself and your family, make sure you know what your insurance will pay and where to turn if you need additional coverage.
Health insurance generally pays 60 to 100 percent of prenatal and delivery costs, including exams, tests, laboratory work, labor and delivery. In addition, many insurance plans have programs and classes to help mothers- (and fathers-) to-be prepare for birth. Studies from the Institutes of Medicine show that women with health insurance get more prenatal care and in general have healthier babies.
Many people assume that their health insurance will cover most or all of the cost of pregnancy. In fact, many health plans provide limited coverage for prenatal care or delivery. Check your health plan’s certificate of coverage to see if it will meet your needs. If you want to change health plans, you may find that some insurers list pregnancy as a pre-existing condition. That can mean waiting for up to six months before coverage begins. The law bars group health plans offered by employers from considering pregnancy a pre-existing condition. Enrollment in these plans, however, is limited to open enrollment once or twice a year, or when changing jobs.
Remember, maternity coverage ends at childbirth. Be sure to add your newborn to your existing health coverage as soon as possible. There is a grace period for adding your child if he or she needs hospital care right after birth. If you don’t have insurance, ask about enrolling your child with your state’s SCHIP (State Children’s Health Insurance Program).
Women with high co-pays or deductibles may want to explore supplemental maternity insurance. These plans pay for some or all of the costs not covered by regular insurance. Most plans have a waiting period, so the coverage may not be available to women who are already pregnant. Discount maternity programs also pay a percentage of the costs of health exams, tests and hospital stay. Most of these programs require using a preferred provider network to obtain the discount. Not all services will be covered. Most discount plans allow pregnant women to join without a waiting period.
Talk to the benefits manager at your place of employment to learn about the insurance and supplemental coverage available. You can also contact an independent insurance agent to discuss your options. Before signing up for a supplemental or discount maternity plan, make sure the services you need are covered. Try to estimate how much reimbursement you will receive. Make sure you will not pay more in premiums than you receive in benefits.