Top Maternity Insurance Plans In California

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. How To Get The Best Maternity Insurance In California
2. Cost Analysis Of The Best Maternity Health Insurance Plans
3. The California Maternity Insurance Mandate Began July 1st: What Are The Effects?
4. Maternity Insurance When You’re Pregnant: Is It Possible?

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Updated on Jan 1st, 2013

How To Get The Best Maternity Insurance In California

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 you have a good California Maternity Health Insurance plan that will help manage and reduce the financial costs of pregnancy and delivery.

Typical Cost Of A Pregnancy

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 1^st 6 months, 2/mo during months 7 & 8, and weekly during the 9^th month). The average cost of these office visits are about $100-$200/visit. During each office visit, the doctor will order preventive lab tests that will average about $100/visit. Other tests, such as amniocentesis (~$1,500 – $2,000 cost) and ultrasounds (~$550) all add to the total overall costs. Therefore, having health insurance with maternity coverage to help reduce these out of pocket expenses is important.

Key Benefits To Look For In A Good California Maternity Health Insurance Plan:

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. HMO plans will cover the prenatal office visits as a copay, but these plans are expensive.

2. Lower Deductible Amount

The PPO deductible will potentially come into play for your lab tests, and will definitely be a factor for the delivery costs, so having a lower deductible will reduce your out of pocket costs. For HMO plans, the lab tests will usually be covered by a copay, and for the delivery you may have a larger copay for admission to the hospital, or you may have to share the hospital costs with the insurance company at your co-insurance rate.

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 be as low as possible. The same thing applies to HMO plans.

4. Premium Cost of the California Maternity Insurance Plan

For items 1, 2, and 3 above, the premium cost of the maternity plan will be higher as you increase the number of offices visits allowed, or lower the deductible and OOPM amounts. So there is a trade-off between paying more in premiums for the maternity plan versus paying for more of the maternity costs out of your own pocket.

Now for the hard part. Every health plan offered in California must provide maternity coverage, so there are over 100 plans to choose from. This may seem like too much to compare, but if you focus on the 4 Key Benefits outlined above, and pay close attention to the deductible and the out-of-pocket maximums, you will be able to quickly reduce your maternity options to less than 10. This works because the delivery costs will be high enough to force most women to meet the maternity out-of-pocket maximum. So keeping this value small will typically reduce the total costs.

 

Maternity insurance plans from all major health companies in California. Get the best plan!

 

Best Maternity Insurance Plans In California

When you compare all the maternity plans based on the criteria listed above, you get the following 5 plans typically being the best options in San Diego with some variations depending upon the age of the mother-to-be, and where where you live: (see the Recommendation Table)

1. Health Net Platinum 90 HMO

2. Health Net Gold 80 HMO

3. Kaiser Permanente Platinum 90 HMO

4. Sharp Health Plan Platinum 90 HMO

5. Molina Healthcare Platinum 90 HMO

These are the best plans as of January 2017 for San Diego. The top plans in every region of California are shown on the California Maternity Insurance After Obamacare page.

The remainder of this page is old information that is outdated.

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Cigna now holds the top spot and the 5th position on the list, while Kaiser holds the 2nd and 3rd spots, and Health Net sneaks in with spot number 4. One thing you will notice is that the list is still dominated by Health Savings Account (HSA) compatible health plans. To get the full benefit from these HSA plans you must set up the savings account to get the tax benefits (every dollar you put into the HSA, to pay for medical expenses, reduces your taxable income by a dollar). Check the Best HSA Health Insurance Plans In California page to get more information about HSA plans.

Check below to see the analysis behind these recommendations!

Many people have a very black and white perspective on Kaiser Permanente. They either love Kaiser or they hate Kaiser. So seeing Kaiser near the top of the list may be a disappointment to some, but the Kaiser plans can cut your out of pocket costs by 35% – 50% in comparison to the average medical plan. There are plenty of pregnancy plan options from the other carriers.

Finding a good California Maternity plan can be a difficult process unless you know what to look for. The information is scattered and hard to find, and there are trad-eoffs between the cost of the maternity 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 quote to compare the above plans and find out which is best for you.

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

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Updated on Jan 1st, 2013

Cost Analysis Of The Best Maternity Health Insurance Plans

As we showed above, the five best maternity policies are from CIGNA, Kaiser Permanente, and Health Net’s California Farm Bureau. 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 Total Cost of each plan is determined by adding up the costs of all the prenatal office visits and lab tests, combining that with the costs that you would pay for delivery at a hospital, and then adding the premiums you pay for the plan over a full year. So we’ve got costs for 14 office visits and labs, 1 amniocentesis, 1 Ultrasound, 1 hospital delivery, and 12 months of premiums.

The analysis of each plan is outlined below:

Cigna Health Savings 1900

8 prenatal office visits X $150/visit =	$1200 +
6 prenatal office visits X $150 X 30% Coinsurance =	$270 +
7 prenatal office visit labs X $100/lab =	$700 +
7 prenatal office visit labs X $100 X 30% Coinsurance =	$210 +
{at the 8th office visit the plan’s $1900 deductible is met}
Amniocentesis $1000 x 30% =	$120 +
{the Maximum Out Of Pocket (MOOP) limit of $2500 is met}
Ultrasound test X $0/test =	$0 +
Hospital Copay $300/day for 2 days =	$0 +
Hospital Co Insurance 0% =	$0 +
Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs]	$2500
12 X Monthly Premium of $199 =	$2388 +
(Total Before Tax Cost)	$4888
Using HSA to get 15% tax savings on out of pocket costs ($2500 X 15%) =	$375 –
For a Total Out of Pocket Cost of	$4513

 

Kaiser $0/$1500 HSA Deductible

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 is 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 $232 =	$2784 +
(Total Before Tax Cost)	$4984
Using HSA to get 15% tax savings on out of pocket costs ($2200 X 15%) =	$315 –
For a Total Out of Pocket Cost of	$4669

 

Kaiser 50 Copaymant

14 prenatal office visits X $0/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 $302 =	$3624 +
Total Out Of Pocket Cost	$4864

 

Health Net California Farm Bureau HSA 4500

14 prenatal office visits X $150/visit =	$2100 +
14 prenatal office visit labs X $100/lab =	$1400 +
Amniocentesis X $1500/test =	$1000 +
{at this point the plan’s $4500 deductible and MOOP are met}
Ultrasound test X $0/test =	$0 +
Hospital Copay $0 =	$0 +
Hospital Co Insurance 0% =	$0 +
Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs]	$4500
12 X Monthly Premium of $92 =	$1104 +
(Total Before Tax Cost)	$5604
Using HSA to get 15% tax savings on out of pocket costs ($4500 X 15%) =	$675 –
For a Total Out of Pocket Cost of	$4929

 

Cigna HSA 3400

14 prenatal office visits X $150/visit =	$2100 +
13 prenatal office visit labs X $100/lab =	$1300 +
{at this point the plan’s $3400 deductible and MOOP are met}
1 prenatal office visit labs X $0/lab =	$0 +
Amniocentesis X $0/test =	$0 +
Ultrasound test X $0/test =	$0 +
Hospital Copay $0/day for 2 days=	$0 +
Hospital Co Insurance 0% =	$0 +
Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs]	$3400
12 X Monthly Premium of $170 =	$2040 +
(Total Before Tax Cost)	$5440
Using HSA to get 15% tax savings on out of pocket costs ($3400 X 15%) =	$510 –
For a Total Out of Pocket Cost of	$4930

 

The assumptions for the above calculations are that the maternity insurance California plan lasts 1 year and that the mother becomes pregnant and delivers the baby in that 1 year period. The total hospital costs for the vaginal delivery are expected to be $10,000, with a 2 day hospital stay, and the mother goes through the typical 14 prenatal office visits and various blood and urine tests during each office visit. The premium costs are for a 30 year old woman in San Diego county for a Jan 1st, 2013 effective start date.

The biggest factor in determining the lowest Total Out Of Pocket Cost is the deductible and the Maximum Out Of Pocket (MOOP) limit for the plans. These two numbers set the upper limit on the total cost to have a baby. So the better plans tend to have lower deductibles and MOOPs. In fact, the deductible’s effect on the total cost out-weighs the benefit of having a low copay for all prenatal office visits. So pay close attention to the plan deductibles.

Another big factor in lowering the overall cost of having a baby, is the use of a Health Savings Account (HSA). The analysis above shows that using an HSA results in a savings of 8% to 12%, or $315 to $675. So determine if the plan you choose is HSA compatible, and if so, set up and use an HSA account to reduce your costs.

Find more information on HSA insurance plans and their tax-free savings accounts here.

An interesting observation from the analysis is that the premium cost of the top 5 plans ranges from $92 to $302 per month, and the higher premium cost plans are not necessarily worse than the lower premium plans. 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. Most of the plans listed above have fairly equal premium and out of pocket costs. The Cigna Savings 1900 plan, the best maternity insurance plan in California, has it’s total cost almost evenly split between the premiums and the out of pocket costs.

Using the outline above, a couple can determine what they should expect to pay out of pocket for any of the California maternity insurance plans. The plans highlighted in this analysis are the five having the lowest total out of pocket costs. Because all medical plans in California must now provide maternity care, the options now have much lower total costs than the few plans offered earlier this year.

Ultimately, the best maternity insurance coverage is the one that provides quality of care while reducing your total out of pocket costs. To determine this you need to consider both the premium cost of the pregnancy insurance plan as well as the expected out of pocket costs. This way you can get the right combination of quality care and cost.

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Maternity insurance plans from all major health insurance companies in California. The best deals!

 

 

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

In October of 2011, Governor Brown signed a new mandate that all medical plans in California had to include Maternity Coverage starting on July 1st of 2012. The new plans and pricing have been rolled out by all the carriers and the net result is a positive change.

Many carriers kept their existing plans and simply added maternity care (Aetna, Anthem Blue Cross, and Cigna). Others created a completely new portfolio of plans that provide maternity care (Blue Shield, Health Net, and the California Farm Bureau).

Almost every California carrier raised the prices on their plans to compensate for the added risk of covering a new baby with complications. But overall, the increased choices means that women can find many plans that will help them cover the cost of having a baby without having to mortgage their house to do so. Last year there were only 2 plans that had a Total Out Of Pocket Cost less than $5000. As of July 1st, the top 5 plans are below $5000. So there are better choices now.

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Maternity Insurance When You’re 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 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). Carriers 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 coverage coming soon
Resource Links for Maternity Information