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California Maternity Health Insurance

ALERT! Because of the Obamacare changes, all updated information has been moved to a new page, California Maternity Insurance After Obamacare. See the new plans there.

 

Table of Contents

  1. Best California Maternity Health Insurance Plans
  2. Analysis of Best California Maternity Health Insurance Plans
  3. List of California Maternity Health Insurance Plans
  4. California Maternity Insurance Mandate Begins July 1st: What Are The Effects?
  5. Maternity Health Insurance for the Pregnant: Is It Possible?

 


Updated on October 3, 2011

Best California Maternity Health Insurance Plans

Pregnant Woman with Stethescope

1. Office Visits covered by a copay

Prenatal care is not considered preventive and therefore unless your PPO plan offers unlimited office visits, these costs are part of your PPO deductible costs.

2. Lower Deductible Amount

The deductible will come into play for your lab tests and the delivery costs, so having a lower deductible can help to reduce your out of pocket costs.

3. Lower Out Of Pocket Maximum(OOPM)

Once you reach the OOPM, the California maternity health insurance company pays for all additional expenses, so for PPO plans you’ll want this to be as low as possible.

4. Premium Cost of the California Maternity Health Insurance Plan

When you compare all the maternity plans based upon the 4 criteria listed above, you get the following plans typically being the best options with some variations depending upon the age of the mother-to-be: (see the Health Insurance Plan Recommendation Table)

  1. Kaiser 0/1500 HSA Deductible

  2. Kaiser $50 Copayment HMO

  3. Anthem Blue Cross Select HMO*

  4. Health Net HMO 40 NG

  5. Blue Shield Spectrum 5000 PPO

As you can see from the list above, HMO plans are a good fit for maternity care because most benefits are a co-payment, most of the time there is no deductible, and if there is a deductible in the HMO plan it is usually smaller than the deductibles in the PPO plans that provide maternity care. When you combine the cost of the California Maternity Health Insurance plan premiums with the out of pocket expenses incurred during a normal pregnancy, these plans have the lowest overall cost while providing the best care a new mother could want.

Check below to see the analysis behind these recommendations!

What I recommend is that you sign up for Kaiser’s 0/1500 HSA PPO plan, and then about 6-9 months after the baby is born, look at getting non-maternity health insurance from another company for you and the baby. You will save thousands of dollars by doing this (for a 30 year old woman the cost savings of having the Kaiser plan versus the Health Net HMO 40 plan is $3254). It’s hard to ignore a cost difference that large.

Finding a good California Maternity Health Insurance plan can be a difficult process because the choices are limited, the information is scattered and hard to find, and there are tradeoffs between the cost of the insurance plan and the out of pocket costs for the maternity care and delivery. Here we have simplified the process by summarizing the best options for maternity care, so go ahead and get a maternity health insurance quote to see which plan is best for you.

* – The Blue Cross Select HMO uses a smaller network of physicians than the other Blue Cross HMO plans, so you need to verify that your doctor is in the “Select” network.

Stop by later to read upcoming posts about how to reduce your maternity costs!

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Lowest California Maternity Health Insurance Prices Anywhere

The Department of Insurance regulates California maternity health insurance premiums. It doesn’t matter if you go directly to the insurance company, or apply with SPF Insurance, you get the same low price wherever you go. Working with SPF to get maternity insurance California citizens will find the information and help they need to simplify the process so it’s fast and easy.

COMPARE YOUR RATES
3 Steps:
1. Quote 2. Compare 3. Apply

California Maternity Insurance Plans

Rates As Low As
$70


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Maternity Insurance California


Updated on May 8, 2012

Analysis of Best California Maternity Health Insurance Plans

As we showed above, the two best maternity health insurance plans are from Kaiser Permanente, followed by plans from Blue Cross, Health Net, and then Blue Shield. This order was determined by looking at all the out of pocket costs for a typical woman in each of the plans and picking the plans that had the smallest total cost.

The analysis of each plan is outlined below:

Kaiser 0/1500 HSA

14 prenatal office visits X $0/visit = $0 +
14 prenatal office visit labs X $100/lab = $1400 +
Amniocentesis $100 (last of deductible) + $50/test = $150 +
{at this point the plan’s $1500 deductible has been met}
Ultrasound test X $50/test = $50 +
Hospital Copay $300/day for 2 days = $600 +
Hospital Co Insurance 0% = $0 +
Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] $2200
12 X Monthly Premium of $214 = $2568 +
(Total Before Tax Cost) $4768
Using a HSA to get 15% tax savings on the out of pocket costs ($2200 X 15%) = $330 -
For a Total Out of Pocket Cost of $4438

Kaiser 50 Copaymant

14 prenatal office visits X $40/visit = $0 +
14 prenatal office visit labs X $10/lab = $140 +
Amniocentesis X $50/test = $50 +
Ultrasound test X $50/test = $50 +
Hospital Copay $500/day for 2 days = $1000 +
Hospital Co Insurance 0% = $0 +
Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] $1240
12 X Monthly Premium of $279 = $3348 +
Total Out Of Pocket Cost $4588

 

Blue Cross Select HMO*

14 prenatal office visits X $25/visit = $350 +
14 prenatal office visit labs X $0/lab = $0 +
Amniocentesis X $0/test = $0 +
Ultrasound test X $0/test = $0 +
Hospital Copay $250/day for 2 days= $500 +
Hospital Co Insurance 0% = $0 +
Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] $850
12 X Monthly Premium of $564 = $6768 +
Total Out Of Pocket Cost $7618

 

Health Net HMO 40

14 prenatal office visits X $40/visit = $560 +
14 prenatal office visit labs X $0/lab = $0 +
Amniocentesis X $0/test = $0 +
Ultrasound test X $0/test = $0 +
Hospital Copay $1500 deductible = $1500 +
Hospital Co Insurance 0% = $0 +
Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] $2060
12 X Monthly Premium of $510 = $6120 +
Total Out Of Pocket Cost $8180

 

Blue Shield Spectrum 5000 PPO

14 prenatal office visits X $150/visit = $2100 +
14 prenatal office visit labs X $100/lab $1400 +
Amniocentesis X $1000/test = $1000 +
Ultrasound test X $550/test = $500 +
{at this point the plan’s $5000 deductible has been met}
Hospital Copay $0 = $0 +
Hospital Co Insurance 30% of $10k = $2990 +
{at this point the plan’s $7000 max out of pocket has been met}
Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] $7000
12 X Monthly Premium of $180 = $2160 +
Total Out Of Pocket Cost $9160

 

An interesting observation from the analysis is that even though the Kaiser 0/1500 HSA plan has higher out of pocket costs for the prenatal care and delivery in comparison to many of the other HMO plans, the cost savings from the lower monthly premiums and from the tax savings, enables it to have the lowest total out of pocket costs. Without the tax savings from the HSA account, the Kaiser 0/1500 HSA plan would have been 2nd behind the Kaiser 50 Copaymanet plan.

The second observation is that plans with the lowest monthly premiums, aren’t usually the best in lowering your total out of pocket costs during the pregnancy and delivery (the Blue Shield Spectrum 5000 PPO plan has the lowest monthly premium, but is 5th best). However, plans that minimize the prenatal and delivery out of pocket costs also aren’t the best options (the Blue Cross Select HMO plan has the smallest out of pocket costs, but is 3rd best). It’s the combination of the premium costs and the out of pocket costs that determines which plan will result in the lowest total out of pocket cost.

Using the outline above, a couple can determine what they should expect to pay out of pocket for any of the California maternity health insurance plans. The plans highlighted in this analysis are the five having the lowest total out of pocket costs, with the best option being chosen from each of the insurance companies that offer maternity coverage (Kaiser offers several plans that are lower cost than the other insurance companies but only the 2 best Kaiser plans are shown).

For more information on HSA plans and their tax-free savings accounts, stop back to see an upcoming article.

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List of California Maternity Health Insurance Plans

Here are the health insurance plans with maternity coverage that are offered in California. This list is sorted alphabetically by health insurance company, and shows if the plan is an HMO or a PPO. This list is offered solely for use in finding the maternity plans in a maternity health insurance quote.

 

 

Maternity Plan Name Plan Type (HMO/PPO)
Anthem Blue Cross Lumenos HSA 5000 PPO
Anthem Blue Cross PPO Share 3500 PPO
Anthem Blue Cross PPO Share 5000 PPO
Anthem Blue Cross PPO Share 7500 PPO
Anthem Blue Cross Select HMO HMO
Anthem Blue Cross Saver HMO HMO
Anthem Blue Cross HMO HMO
Blue Shield Spectrum 5000 PPO
Blue Shield PPO Plan 5500 PPO
Blue Shield HMO Access + Value HMO
Blue Shield HMO Access + HMO
Health Net HMO 40 NG HMO
Kaiser 0/5000 HSA Deductible HMO(like PPO)
Kaiser 30/2700 HSA Deductible HMO(like PPO)
Kaiser 0/2700 HSA Deductible HMO(like PPO)
Kaiser 0/1500 HSA Deductible HMO(like PPO)
Kaiser 40/2000 Deductible HMO(like PPO)
Kaiser 30/1500 Deductible HMO(like PPO)
Kaiser 25/1000 Deductible HMO(like PPO)
Kaiser 20/500 Deductible HMO(like PPO)
Kaiser $50 Copayment HMO
Kaiser $40 Copayment HMO
Kaiser $25 Copayment HMO

The Kaiser “Deductible” plans are HMO plans in that you have a primary care physician that will refer you to any specialists you need to see, however, the plan benefits are structured to look like a traditional PPO with a deductible and an out of pocket maximum. For more details on what these PPO terms mean see the article 4 Keys To Understanding Insurance Plans on the “Health Insurance Quote Information” page of the website.

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California Maternity Insurance Mandate Begins July 1st: What Are The Effects?

In October of 2011, Governor Brown signed a new mandate that all health insurance plans in California had to include Maternity Coverage starting on July 1st of 2012. We are quickly approaching that date and many people are wondering what the effects of the mandate will be.

So far we have seen small price increases from most of the carriers (2-6% increases), and now it looks like we will see even more insurance companies competing with maternity plans. Previously, Aetna and CIGNA did not offer maternity plans, but both companies have indicated that they will add those benefits to their plans.

As a result, this means I have to quickly finish the analysis of over 120 new plans so I can update the “Best California Maternity Insurance Plans” information from above. One key issue that we’re trying to get clarification on involves the prenatal office visits. Will they be considered “preventive” or “regular” office visits, and therefore covered by a simple copay, free, or limited in quantity. Once we have that information we’ll update this page.

So stay tuned and check back soon to see what the results are!

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California Maternity Health Insurance for the Pregnant: Is It Possible?

The short answer is probably not, unless you qualify for one of three insurance options, or a state provided assistance program. The reason is that the insurance companies view being pregnant as a “Pre-existing Condition,” the costs associated with normal pre-natal and delivery care are much higher than the combined monthly premiums for a maternity health insurance plan, and if there are any complications then the costs quickly climb at an exponential rate (a premature baby can have over $30,000 – $85,000 in medical costs in the first few weeks, and premature birth affects more than 1 in 10 California babies). Health insurance companies therefore will decline an application from a woman that is pregnant at the time of the application. So the mother to be needs to explore other alternative strategies to get maternity coverage.
See the rest of this information on the Health Insurance For Pregnant Women page of the website.

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More articles on California Maternity Health Insurance coming soon
Resource Links for Maternity Information

 

Lowest California Maternity Health Insurance Prices Anywhere

The Department of Insurance regulates California maternity health insurance premiums. It doesn’t matter if you go directly to the insurance company, or apply with SPF Insurance, you get the same low price wherever you go. Working with SPF to get maternity insurance California citizens will find the information and help they need to simplify the process so it’s fast and easy.

COMPARE YOUR RATES
3 Steps:
1. Quote 2. Compare 3. Apply

California Maternity Insurance Plans

Rates As Low As
$70

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