If you're thinking about getting pregnant or already are pregnant, it is wise to make sure you have helpful health insurance and a financial plan to prepare. Although the process can be overwhelming, and the costs can seem like an obstacle, rest assured that hundreds of babies were born in the minute you've taken to read this introduction. Parents have made a way, and you will too. We hope this information helps you to prepare for one of life's greatest adventures.
Since the Affordable Care Act (ACA), all health insurance plans must cover pregnancy, delivery, and newborn care. This goes for government health insurance Marketplace plans, private health insurance through an employer, and all new individual health insurance plans. Exceptions include some individual health care plans that have been grandfathered in and short-term health insurance. It is best to check your benefits summary to be sure.
Health coverage should include prenatal doctor visits, at least one ultrasound, delivery at a hospital, and postnatal checkups for the baby and mother.
Insurance has to cover at least 48 hours of hospital stay after your baby is born if you have a vaginal delivery or 96 hours if you have a C-section. Most hospitals note the hour and minute your baby is born and aim to discharge you from the hospital 48 hours later (or 96 hours later) unless that's in the middle of the night. Sometimes doctors will authorize moms to take home their babies before the 48-hour window, but they often prefer to keep an eye baby and mom while everyone is recovering from delivery.
Learn what providers are in-network for the health insurance policy
If you already have a primary care doctor, make sure they are in-network with the new insurance policy.
Find out what obstetrics care providers are in-network and check their ratings.
Think about what type of delivery you would like if everything goes according to plan. Some hospitals or birthing centers (which can be cheaper!) have exceptional delivery environments. Some obstetrics doctors work as a team, and you have the chance to get to know several of them so that whoever is on call during your delivery will be familiar to you.
Make sure your closest hospital is in-network. Although you may have a dream plan to use a birthing center, a home birth, or the best hospital in your state, you don't want to have to drive an extra 45 minutes to get to a hospital in your network if things don't go according to plan.
Do the math when deciding between a higher premium or a higher deductible.
In whatever year you have a baby, you will reach your deductible. This may make a higher premium more cost-effective than a higher deductible. For instance, if you have a $2,500 deductible, you know you will be paying that much and more to have your baby. If instead you opt to pay a premium that is $100/month higher, yet have a $500 deductible, you will pay an additional $1,200 for your premium, but your net cost will be only $1,700, including your deductible.
The easiest way to answer this question is to look for the Summary of Benefits and Coverage (SBC) for the plan you're considering. Most of these include a breakdown of the costs of having a baby. Often they will make a note of the amount for a vaginal birth as well as a C-section. (C-sections require a surgical team and an extra two days in the hospital, and are therefore more expensive.)
Check out these out-of-pocket averages from 2018, as reported by Fair Health, a nonprofit devoted to data collection and analysis.
Vaginal delivery: $5,000-$11,000 in most states (includes pre- and postnatal care, anesthesiology, and hospital stay.)
C-section births range on average from $7,500-$14,500
Complications to either type of birth increase the charges
Having a baby with no insurance costs about twice as much as it costs with insurance. In this report from 2018, Business Insider details the average costs for pregnancy care by state (with data also provided by Fair Health.)
If you don't already have insurance, don't count on being able to sign up for a Healthcare.gov insurance policy in the middle of the year. The Affordable Care Act (ACA) Marketplace insurance (Healthcare.gov) has an open enrollment period between November 1 and December 15. That qualifies you to start a plan that's effective January 1 of the following year. In order to sign up for coverage during a different time of the year, you have to have had a qualifying life event.
The good news is that having a baby is a qualifying life event.
After you have your baby, you can enroll in or change Marketplace coverage even if it's outside the Open Enrollment Period. When you enroll in the new plan, your coverage can be effective from the day the baby was born. —Healthcare.gov
The less encouraging news is that your prenatal care may not be covered, because getting pregnant is not considered a qualifying life event. It is important for pregnant women to get proper care and insurance typically covers a lot of that care. This points to the importance of always being insured since, for many families, you never knew when pregnancy might happen!
Medicaid and CHIP cover all pregnancy and delivery costs. They allow year-round enrollment, so if you get pregnant and don't have insurance or have very poor employer insurance options, it may be worth checking your eligibility. You can do this by calling your state agency or by filling out an application on Healthcare.gov. If you qualify for Medicaid or CHIP, the Marketplace application will be forwarded to the proper state agency.
A word about signing up for Medicaid or CHIP when you're pregnant: The paperwork can be overwhelming, and the deadlines for getting it turned in are sometimes difficult to keep. It's common to wait on the phone for 30 minutes to get the necessary information. However, if you've received a notice that you're eligible for Medicaid or CHIP, do everything you can to get the proper paperwork in on time and deal with the hassle. The benefits offered by these government programs are phenomenal—better than any other insurance plan. Most pregnant women enrolled in these programs pay very little for obstetrics, delivery, and postnatal care. The best advice is to get help if you're feeling overwhelmed, but don't give up!
So you've had your baby! Congratulations! Call your insurance company. You can choose to add your child to your plan, or you can change plans. As mentioned before, having a baby is considered a qualifying life event, so you should be able to change plans if you prefer.
It's very helpful to have already figured out what you want to switch to before you have the baby. Mom, if you're the one who usually takes care of the financials in your home, make sure your partner is in the loop so they can be the one to make the call. Typically, you have a 30-60 day window of time after the baby is born to make these changes. But it is advisable to do soon after leaving the hospital.
Experienced parents will laugh at this heading. Pregnancy, delivery, and certainly, infant care can seem to be anything but predictable. But in terms of healthcare costs, it is more predictable than falling off a ladder or some other negative health event! With pregnancy, you can use your advanced knowledge to prepare.
If you are feeling overwhelmed by the high costs of having a baby, even with insurance, take a deep breath, get a friend or an advisor to help, and make a plan. No doubt, your child will be worth it all.