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California Maternity Insurance After Obamacare


After a lot of delay in getting health plans approved by the California Department of Insurance, the insurance companies in California finally have approval to offer all their health plans. And although health care reform (Obamacare) was supposed to reduce costs, and make benefits like maternity coverage mandatory, the results are not very attractive.Best Health Insurance In California For MaternityThis is especially apparent when comparing the new Obamacare maternity insurance benefits here in California.

We’ll briefly cover the key benefits you’ll want in good maternity insurance, then we’ll show you the Best California Maternity Insurance Plans, and we’ll review how Obamacare has effected maternity care options in California. Finally, we’ll give you a simple step by step process to find the right health coverage for your pregnancy and delivery.

Maternity Insurance Plans Need These Key Benefits

A standard pregnancy has 14 prenatal office visits, various lab tests performed during each office visit, amniocentesis, and 1 or 2 ultra-sounds. After the prenatal period the next big cost is the actual delivery. A typical delivery is a 2 day hospital stay, and a C-section requires 3 days.With these standard services in mind, the key benefits that a good maternity plan will provide, are the following:

  1. Unlimited Doctor Office Visits for a Copay
  2. All the new Obamacare plans now offer Prenatal office visits as a preventive service. You’ll have a $0 copay for these visits in Bronze, Silver, Gold, and Platinum policies.

  3. Low Deductible or No Deductible
  4. At some point, your baby will be born, and when that time comes, you have to reach the deductible before your insurance company begins paying for any part of the delivery costs.

  5. Small Out Of Pocket Maximum
  6. Once you meet the deductible, you begin sharing costs (co-insurance) with the insurance company until you reach your out-of-pocket maximum. All the Bronze, Silver, and Gold policies have a $6,350 out-of-pocket maximum. Only the Platinum plan has a lower limit at $4,000.

  7. Fixed Copay for Hospital Stays
  8. Some plans, HMOs, require a co-payment for inpatient care at a hospital while others, PPOs, require the co-insurance mentioned above. The HMO co-payment is usually on a per-day basis. An HMO maternity plan with a lower per-day co-pay will minimize your costs more than a PPO policy.

  9. Fixed Copay for Lab Tests and Imaging
  10. During each prenatal office visit your doctor will order lab tests to check on your health and the health of your baby. Having co-payments for lab tests instead of them being part of the deductible costs is ideal. Bronze plans make the lab tests part of your deductible, while Silver, Gold, and Platinum plans offer co-pays for lab tests.

  11. Affordable Monthly Premium

The monthly premium is a big part of the total out of pocket cost to have a baby. Having a lower premium can help.

These benefits are all important, but the largest reduction in overall costs can typically be obtained by picking a plan that reduces the delivery costs to a co-pay. This makes HMO plans the best option in most areas.

If having the flexibility of a PPO plan is important, then you must pick a plan with the lowest out-of-pocket maximum, co-insurance percentage, and deductible. PPO plans are typically used when a specific doctor is wanted, and that physician is not part of a major medical group.

Depending upon what time of the year you plan to begin trying to get pregnant, there are some strategies that can help lessen the insurance costs. See the section titled Planning Tips For Pregnancy Health Insurance Plans below.

Finally, the maternity insurance plans and prices are different in many areas of California, so analysis of the specific maternity plans in your area is important.



Best Maternity Insurance In California Post Obamacare

The best pregnancy health insurance plans in each region of California are a little bit different. This happens because many of the smaller insurance companies only operate in a few of the 19 regions. Plus some of the major companies are not available in every region.

Select the tab with the name of your county/region to see the top maternity plans for you.

  1. Health Net CommunityCare Platinum (HMO)
  2. Total Out Of Pocket Costs (TOOPC) = $4,572

  3. Sharp Health Plan Premier Platinum (HMO)
  4. TOOPC = $4,980

  5. Health Net CommunityCare Gold (HMO)
  6. TOOPC = $5,012

  7. Kaiser Permanente CA Platinum 0/20 (HMO)
  8. TOOPC = $5,280

  9. Assurant Health Coremed Platinum 1 (PPO)
  10. TOOPC = $5,402

  11. Sharp Health Plan Premier Gold (HMO)
  12. TOOPC = $5,576

  13. Assurant Health Coremed Gold 1 (PPO)
  14. TOOPC = $5,732

  15. Cigna myCigna Health Flex 1900 Gold (PPO-HSA)
  16. TOOPC = $5,757

  17. Kaiser Permanente CA Gold 0/30 (HMO)
  18. TOOPC = $5,828

  19. Anthem Blue Cross Premier DirectAccess (EPO)
  20. TOOPC = $5,960

  21. Blue Shield Ultimate PPO
  22. TOOPC = $5,984

  23. Anthem Blue Cross Premier Guided Access (HMO)
  24. TOOPC = $6,012

  25. Anthem Blue Cross Preferred Guided Access (EPO)
  26. TOOPC = $6,224

Total Out Of Pocket Cost in California
is based upon a 30 year old woman, including 12 months of premiums, a full 9 months of regular prenatal care, and a standard hospital delivery (C-section delivery would cost more)
The Health Net CommunityCare network is only available in some southern California areas, and is a very small network of community clinics and lower cost providers. The Sharp Health Plan options are only available in San Diego county, and include all the Sharp providers and hospitals. The Cigna plans are available in Southern California and the Bay Area, and have fairly strong networks in both of those areas.

The most notable differences between 2013 and 2014 maternity plans is that HMO plans dominate, and the TOOPC is mostly higher in 2014.

The Health Net CommunityCare Platinum HMO plan provides the lowest TOOPC of all the 2014 plans, but has a higher TOOPC than the best 2013 plan which had a TOOPC of $4,513. The remainder of the 2014 plans have higher TOOPCs than the 2013 plans. The top 5 2013 California maternity insurance plans had TOOPCs less than $5,000 where only two of the 2014 plans are below that level.

To see the detailed breakdown of the Total Out Of Pocket Costs for the San Diego California maternity insurance options, click here.

  1. Kaiser Permanente CA Platinum 0/20 (HMO)
  2. TOOPC = $5,988

  3. Cigna myCigna Health Flex 1900 Gold (PPO-HSA)
  4. TOOPC = $6,069

  5. Blue Shield Ultimate PPO
  6. TOOPC = $6,368

  7. Cigna Covered California Platinum Coinsurance Plan (PPO)
  8. TOOPC = $6,940

  9. Anthem Blue Cross Premier DirectAccess (PPO)
  10. TOOPC = $7,136

Total Out Of Pocket Cost in California
is based upon a 30 year old woman, including 12 months of premiums, a full 9 months of regular prenatal care, and a standard hospital delivery (C-section delivery would cost more)
The most notable differences between 2013 and the 2014 best California maternity insurance plans is that higher cost Platinum plans dominate and the TOOPC is higher in 2014.

In 2013 the top 5 plans had TOOPCs of less than $5,000, and in 2014 the lowest is $5,988. Obamacare did nothing to help with maternity insurance in California.

To see the detailed breakdown of the Total Out Of Pocket Costs for the Contra Costa California maternity insurance options, click here.

  1. Health Net CommunityCare Platinum (HMO)
  2. Total Out Of Pocket Costs (TOOPC) = $4,344

  3. Health Net CommunityCare Gold (HMO)
  4. TOOPC = $4,808

  5. Anthem Blue Cross Premier GuidedAccess (HMO)
  6. TOOPC = $5,232

  7. Assurant CoreMed Platinum 1 (PPO)
  8. TOOPC = $5,306

  9. Kaiser Permanente CA Platinum 0/20 (HMO)
  10. TOOPC = $5,508

  11. Blue Shield Ultimate PPO (PPO)
  12. TOOPC = $5,552

  13. Cigna myCigna Health Flex 1900 Gold (PPO-HSA)
  14. TOOPC = $5,553

Total Out Of Pocket Cost in California
is based upon a 30 year old woman, including 12 months of premiums, a full 9 months of regular prenatal care, and a standard hospital delivery (C-section delivery would cost more)
The most notable differences between 2013 and the Obamacare maternity plans is that fewer insurance companies offer coverage here and the TOOPC is higher in 2014.

In 2013 3 of the top 5 plans had TOOPCs of less than $5,000, and in 2014 the lowest is $5,456. Obamacare did nothing to help with maternity insurance in California.

To see the detailed breakdown of the Total Out Of Pocket Costs for the Fresno, Kings, and Madera California maternity insurance options, click here.

  1. Blue Shield Ultimate PPO
  2. TOOPC = $5,456

  3. Kaiser Permanente CA Platinum 0/20 (HMO)
  4. TOOPC = $5,460

  5. Anthem Blue Cross Premier DirectAccess (PPO)
  6. TOOPC = $5,720

  7. Anthem Blue Cross Premier GuidedAccess (HMO)
  8. TOOPC = $6,024

  9. Anthem Blue Cross Preferred DirectAccess (PPO)
  10. TOOPC = $6,280

Total Out Of Pocket Cost in California
is based upon a 30 year old woman, including 12 months of premiums, a full 9 months of regular prenatal care, and a standard hospital delivery (C-section delivery would cost more)
The most notable differences between 2013 and the Obamacare maternity plans is that fewer insurance companies offer coverage here and the TOOPC is higher in 2014.

In 2013 3 of the top 5 plans had TOOPCs of less than $5,000, and in 2014 the lowest is $5,456. Obamacare did nothing to help with maternity insurance in California.

To see the detailed breakdown of the Total Out Of Pocket Costs for the Fresno, Kings, and Madera California maternity insurance options, click here.

  1. Health Net CommunityCare Platinum (HMO)
  2. Total Out Of Pocket Costs (TOOPC) = $4,200

  3. Health Net CommunityCare Gold (HMO)
  4. TOOPC = $4,676

  5. Anthem Blue Cross Premier GuidedAccess (HMO)
  6. TOOPC = $4,824

  7. Assurant CoreMed Platinum 1 (PPO)
  8. TOOPC = $5,090

  9. Kaiser Permanente CA Platinum 0/20 (HMO)
  10. TOOPC = $5,412

  11. Assurant CoreMed Gold 1 (PPO)
  12. TOOPC = $5,480

  13. Cigna myCigna Health Flex 1900 Gold (PPO-HSA)
  14. TOOPC = $5,505

  15. Blue Shield Ultimate PPO (PPO)
  16. TOOPC = $5,516

Total Out Of Pocket Cost in California
is based upon a 30 year old woman, including 12 months of premiums, a full 9 months of regular prenatal care, and a standard hospital delivery (C-section delivery would cost more)
The most notable differences between 2013 and the Obamacare maternity plans is that HMO plans dominate the top of the list, and the TOOPC is higher in 2014.

In 2013 all 5 of the top plans had TOOPCs of less than $5,000, and four of those were PPO plans. In 2014, only 3 are below $5,000 and only one is a PPO plan. Obamacare requires you to now make a choice between staying with your Obstetrician and paying a higher price for PPO coverage, or opting to pay less by selecting a physician from a smaller, lower cost HMO network.

To see the detailed breakdown of the Total Out Of Pocket Costs for the South Los Angeles maternity insurance California options, click here.

  1. Health Net CommunityCare Platinum (HMO)
  2. Total Out Of Pocket Costs (TOOPC) = $3,880

  3. LA CARE Covered  Platinum (HMO)
  4. TOOPC = $4,224   (only on Exchange)

  5. Health Net CommunityCare Gold L (HMO)
  6. TOOPC = $4,400

  7. Molina Healthcare Platinum 90 (HMO)
    TOOPC = $4,488
  8. Anthem Blue Cross Premier GuidedAccess (HMO)
  9. TOOPC = $4,752

  10. Kaiser Permanente CA Platinum 0/20 (HMO)
  11. TOOPC = $4,968

  12. Blue Shield Ultimate PPO (PPO)
  13. TOOPC = $5,000

  14. Assurant CoreMed Platinum 1 (PPO)
  15. TOOPC = $5,090

Total Out Of Pocket Cost in California
is based upon a 30 year old woman, including 12 months of premiums, a full 9 months of regular prenatal care, and a standard hospital delivery (C-section delivery would cost more)
The most notable differences between 2013 and the Obamacare maternity plans is that HMO plans dominate the top of the list, and the TOOPC is higher in 2014.

In 2013 all 5 of the top plans had TOOPCs of less than $5,000, and four of those were PPO plans. In 2014, only 3 are below $5,000 and only one is a PPO plan. Obamacare requires you to now make a choice between staying with your Obstetrician and paying a higher price for PPO coverage, or opting to pay less by selecting a physician from a smaller, lower cost HMO network.

To see the detailed breakdown of the Total Out Of Pocket Costs for the South Los Angeles maternity insurance California options, click here.

…..

The overall effect of Obamacare on maternity health insurance in California has mostly been negative. The new health care reform offerings with the lowest total out of pocket costs are all much higher priced than in 2013. There are fewer PPO options, and many Ob/GYNs are in only one or two networks, so the selection of a good plan is more important than ever.


Golden Gate Bridge in California


How To Select The Best California Maternity Insurance

The new Obamacare maternity options are not as good as they were in 2013, and the overall effect is to make the process of selecting good pregnancy coverage more difficult.

We’ll give you a simple step by step approach to make it a little bit easier.

  1. Determine if you can qualify for a subsidy
  2. Check with your doctor to determine which networks are accepted
  3. Run a California maternity insurance quote to get your plans and rates
  4. Use the lists above as your starting point
  5. Select the plan that will reduce your total costs and your doctor accepts
  6. Fill out the CoveredCA.com application if you qualify for a subsidy, or use the “Apply Now” link in your quote if you do not qualify for a subsidy

If you need help determining which Obamacare plans are the best in your region of California, call us and we’ll help you pick the right plan. If you have any questions contact us.


Planning Tips For Pregnancy Health Insurance Plans

If you are planning to have a baby and can “time” when you have the baby, there are some ways you can reduce your overall costs for health insurance with maternity coverage in California. We do this by considering the full pregnancy as being composed of two time frames.

  1. The Pre-Natal Period
  2. Delivery Time

During the Pre-Natal Period, you will primarily have multiple office visits. Each doctor visit will require some lab tests to check on the health of you and the baby. For Silver, Gold, and Platinum plans, these pre-natal visits are covered and the labs are a simple co-payment. The difference in co-payments between the plans are not as significant as the monthly premiums of the maternity plans.

Therefore, Silver plans are ideal coverage for the pre-natal period.

At Delivery Time we know there will be a large cost associated with delivery in a hospital. Ideally you want a plan with NO deductible, and a fixed co-payment for the hospital costs. Therefore, Gold and Platinum HMO maternity plans are best. Usually Platinum plans will have a better “benefit versus cost ratio” than the Gold plans.

Therefore, Platinum plans are the best maternity health insurance California plans.

From a timing standpoint, if you know that you can wait until at least April or May to get pregnant, then you can select a Silver plan at the beginning of the year. During the next year’s open enrollment period in the fall, you can then move into a Platinum plan for delivery the next year.

Timeline to get maternity health insurance California

Pick The Best California Insurance For Maternity Based On When You Expect To Deliver The Baby

If you want to really take advantage of an open enrollment loophole, AND you will give birth in January of 2015 or early February 2015 (before 2/15/15). Here’s what you can do. During the 2015 open enrollment, which will start on 11/15/14, move to a Platinum plan for the January 2015 delivery. Once the baby is born, reapply to move back to a Silver plan before the end of the 2015 open enrollment period, which ends on 2/15.

You get to use Platinum benefits for the delivery, and then immediately move back into a lower cost plan.

This will probably only work next year because congress changed the 2015 open enrollment period to extend into 2015. If the insurance companies notice this is happening, there will be a lot of noise, and they will get this loophole closed.


Need Maternity Insurance? Already Pregnant California Woman Are Saved By Obamacare

In the last 10 years, we at SPF Insurance have received hundreds, if not thousands, of calls from women who were pregnant and looking for health insurance. Until this year, we’ve had limited ability to help them get coverage. Obamacare has changed that.

The Affordable Care Act removed the “pre-existing condition” exclusion so that pregnant women can get California health insurance with maternity coverage. During the yearly open enrollment periods you can select any policy you want. Even if you are pregnant at that time.

You must make sure to sign up for a plan during the open enrollment periods. Outside of open enrollment, getting pregnant is not a “qualifying event” that would allow you to apply for coverage. If you become pregnant without insurance, you will either have to qualify for Medi-Cal or Aid For Infants & Mothers (AIM), or pay for your care until the beginning of the next year when you can enroll for pregnancy insurance.


8 Responses Post a comment
  1. jay permalink
    February 28, 2014

    This is really helpful! Thank you!!

  2. jay permalink
    February 27, 2014

    Great video and very informative. Could you do one for L.A. County?

    • February 27, 2014

      Hi Jay,
      We’ve updated the page with the analysis of the maternity plans in the South LA County area where you live.
      Thank you for the feedback.

      Tim

  3. Mandy permalink
    December 11, 2011

    I was very excited to find this comparison of plans with maternity coverage, especially with the specific cost breakdown. I had already figured out that Kaiser is probably best for me, but I’ve been trying to choose between the plans. However, there are two things that I’m confused about. First, according to Kaiser’s brochures and info given me by one of their sales reps (Dec. 2011), routine scheduled prenatal visits ARE covered at no charge on all of the Kaiser health plans that include maternity. Second, you show the office visit copay as $40 for Kaiser 50 Copayment when Kaiser brochures list it at $50. The latter is relatively minor, but the former is extremely huge since it impacts how to calculate deductible/OOP expenses. for the different plans. Can you provide any clarification of this discrepancy? Thank you.

    • December 15, 2011

      Mandy,

      Thank you for visiting the website. I reviewed your questions and realized that we had overlooked the fact that Kaiser includes the pre-natal visits at zero cost in the analysis (none of the other carriers do that). The lab tests for the pre-natal visits will still be part of the deductible for the HSA plans, and a copay for the Copayment plans. I will update the website tomorrow with the new results. The $40 vs $50 copay is a typo we missed (It was copied from the $40 Copay plan to the $50 Copay plan)..
      Oops!

      Tim

  4. Wippert permalink
    August 20, 2011

    Very helpful post man, thanks for the info.

  5. MoriceFoskett32 permalink
    August 16, 2011

    Hello There. I found your weblog using msn. This is an extremely smartly written article. I will be sure to bookmark it and come back to read more of your helpful info. Thank you for the post. I?ll certainly comeback.

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