All maternity insurance plans in California are standardized now. As a result there are only 7 plan types. We’ll show the breakdown the costs of these plans in general order from best to worst. Then we’ll highlight a warning about pre-natal costs.For all the cost breakdowns shown below the Pre-natal Care is considered a preventive service in all health plans. This means you will not pay anything for the office visits or the standard lab tests that are done during each visit. Hospital delivery costs are assumed to be $10,000 in all locations for a standard delivery, and to require a 2 day hospital stay.
Seven Health Plan Types In California
- Bronze HSA plan
- Bronze plan
- Silver plan
- Gold Co-Insurance plan
- Gold Co-pay plan
- Platinum Co-insurance plan
- Platinum Co-pay plan
Platinum Co-Pay Plan Cost Breakdown
The cost to have a baby in a Platinum Co-pay plan is the following:
Total out-of-pocket cost = (monthly health plan premium) x 12 + (in-patient hospital co-pay of $250/day x 2 days)
Total out-of-pocket cost = (monthly health plan premium) x 12 + $500
Gold Co-Pay Plan Cost Breakdown
The cost to have a baby in a Gold Co-pay plan is the following:
Total out-of-pocket cost = (monthly health plan premium) x 12 + (in-patient hospital co-pay of $600/day x 2 days)
Total out-of-pocket cost = (monthly health plan premium) x 12 + $1,200
If the premium cost of the Gold Co-pay plan is [$200/12=$16.67] more than $17/month less than a Platinum Co-Insurance plan, then the Gold plan will have a lower total out-of-pocket cost for maternity.
Platinum Co-Insurance Plan Cost Breakdown
The cost to have a baby in a Platinum Co-insurance plan is the following:
Total out-of-pocket cost = (monthly health plan premium) x 12 + (in-patient hospital co-insurance of 10% x $10,000 delivery)
Total out-of-pocket cost = (monthly health plan premium) x 12 + $1,000
Gold Co-Insurance Plan Cost Breakdown
The cost to have a baby in a Gold Co-insurance plan is the following:
Total out-of-pocket cost = (monthly health plan premium) x 12 + (in-patient hospital co-insurance of 20% x {$10,000 delivery – $2,000)
Total out-of-pocket cost = (monthly health plan premium) x 12 + $2,000
Silver Plan Cost Breakdown
The cost to have a baby in a Silver plan is the following:
Total out-of-pocket cost = (monthly health plan premium) x 12 + $2,000 deductible + (in-patient hospital co-insurance of 20% x {$10,000 delivery – $2,000})
Total out-of-pocket cost = (monthly health plan premium) x 12 + $3,600
This is a better prenatal plan, but not a good maternity delivery plan.
Bronze Plan Cost Breakdown
The cost to have a baby in a Bronze plan is the following:
Total out-of-pocket cost = (monthly health plan premium) x 12 + $5,000 deductible + (in-patient hospital co-insurance of 30% x {$10,000 delivery – $5,000 deductible you’ve already paid})
Total out-of-pocket cost = (monthly health plan premium) x 12 + $6,250. You will reach the Maximum Out-Of-Pocket limit of $6,250 during the delivery.
As you can see, this is not a good option if you plan to have a baby.
Bronze HSA Plan Cost Breakdown
The cost to have a baby in a Bronze HSA plan is the following:
Total out-of-pocket cost = (monthly health plan premium) x 12 + $4,500 deductible + (in-patient hospital co-insurance of 40% x {$10,000 delivery – $4,500})
Pre-Tax Total out-of-pocket cost = (monthly health plan premium) x 12 + $6,250. Assuming you put the full $6,250 into the HSA savings account, then you will save $1,250 on your federal tax return, so your total out-of-pocket cost will be:
After-Tax Total out-of-pocket cost = (monthly health plan premium) x 12 + $5,000.
To see the calculated total out of pocket costs for maternity insurance plans in California, and lists of the best pregnancy plans, check out our “California Maternity Insurance After Obamacare” page.
Pre-Natal Care Health Plan Warning
Although the standard pre-natal care is fully covered as preventive care, that does not mean that all pre-natal care is considered “standard.” If you or your developing baby have anything out of the ordinary that occurs during your pregnancy, you may be asked to pay for the “non-standard” pre-natal care using your regular health insurance coverage.
This means that you should avoid Bronze plans of any type if you are planning to get pregnant. Of all the maternity plans in California, the Silver plans are the lowest cost plan you should select for the pre-natal portion of your pregnancy.
When you are ready to deliver, you should plan to be in a Gold or Platinum plan.
Return to Best Maternity Insurance in California page.