This information is outdated now. SEE THE NEW Obamacare MATERNITY INFORMATION HERE.
Congratulations on your decision to start a family! There are a few planning steps you’ll want to make sure you complete before you become pregnant. The first step is making sure that your finances can support the addition of a new baby. The second step is to make sure you are ready for the hardship and joy of bringing a new baby into the world. The last step is to make sure that you have maternity coverage in your health insurance plan that will help manage or reduce the financial costs of pregnancy and delivery.
It’s not uncommon for a standard pregnancy and delivery to cost between $13,000 to $20,000. The main cost is for the delivery, which in San Diego County averages between $7,700 to $13,100, depending upon the hospital. The next largest cost is for the 12-14 prenatal office visits that are recommended to check on the health of the baby and mother during the pregnancy (1/mo during 1st 6 months, 2/mo during months 7 & 8, and weekly during the 9th month). The average cost of these office visits are about $100-$200/visit. Other tests, such as amniocentesis (~$1,500 – $2,000 cost), blood and urine tests, ultrasound (~$200) all add to the total overall costs. Therefore, having insurance with maternity coverage to help reduce these out of pocket expenses is important.
Right from the beginning, you’ll want a maternity health insurance plan that will help you reduce the costs of your pregnancy and delivery, so the following are the key benefits to look for:
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 insurance company pays for all additional expenses, so for PPO plans you’ll want this to as low as possible.
4. Premium Cost of the maternity coverage Health Insurance Plan
For items 1,2,and 3 above, the premium cost of the insurance plan will be higher as you increase the number of offices visits allowed, or lower the deductible and OOPM amounts. So there is a tradeoff between paying more in premiums for the insurance plan versus paying for more of the maternity costs out of your own pocket.
Now for the hard part. In California there are a limited number of health insurance plans with maternity coverage to choose between. In fact some insurance companies don’t offer any maternity coverage plans (Aetna, Cigna, CA Farm Bureau). This leaves us with Anthem Blue Cross, Blue Shield, Health Net, and Kaiser Permanente, for a total of 17 plans that provide maternity care.
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)
Kaiser $40 Co-payment HMO
Kaiser 0/1500 HSA PPO
Health Net HMO 40
Blue Cross Saver HMO
Blue Shield HMO Access + Value
As you can see from the list above, HMO plans are a good fit for maternity care because most benefits are a co-pay and most of the time there is no deductible, and if there is a deductible in the HMO plan it is usually lower than the deductibles in the PPO plans that provide maternity care.
Many people have very black and white perspectives on Kaiser Permanente. They either love Kaiser or they hate Kaiser. So seeing Kaiser at the top of the list may be a disappointment to some, but the Kaiser plans can cut your out of pocket costs by over 50% in comparison to the best plans from Health Net, Blue Cross, and Blue Shield.
What I recommend is that you sign up for Kaiser’s $40 Co-payment plan and then about 6-9 months after the baby is born you look at getting non-maternity health insurance from another company. You will save thousands of dollars by doing this (for a 32 year old woman the cost savings of having the Kaiser plan versus the Health Net HMO 40 plan is $4594). It’s hard to ignore a cost difference that large.
Finding a good 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. This post has simplified the process by summarizing the best options for maternity care. If there are any questions, one of our advisors would love to help you.
More information on Maternity Health Insurance is now available on the California Maternity Health Insurance page of the website.