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oh baby!
Health Insurance for
Pregnancy, Labor & Birth
by Janelle Durham
(Note, this article is intended to provide
general information, and should not be considered legal advice, or advice
specific to your financial situation.)
According to ehow.com,
“the average cost of having a baby is $6,378 for a normal delivery, $10,638
for a cesarean.” Costs are typically much lower for a home birth or birth
center birth with a midwife, but may still total over $2500.
It’s important to know
what your options are for covering these costs. The best time to find out
about your insurance coverage for pregnancy and birth is before you
get pregnant. However, if you missed that opportunity, do check into
coverage as early in your pregnancy as possible. It is also best to avoid
job changes or other insurance changes during pregnancy. If you are
considering a change, be sure to check out the insurance options before you
commit to anything new.
If you have insurance:
Check your written policy
guidelines, contact your insurance company, or the human resources
department at your work to find out the answers to these questions:
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Does your insurance
cover pregnancy and birth? (Some states require that health plans cover
prenatal care; others do not.)
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What types of health care providers are
covered: OB? Family practice? Midwives? Is there a specific list of
practitioners you must choose from? (Note:
Thirty-one states mandate private insurance reimbursement for midwifery
care, and medicaid reimbursement is mandatory in all 50 states.)
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What birth places are covered: Hospital?
Birth center? Home birth? Are there particular facilities you must use?
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Are there specified co-payments? Do you
need to pay a percentage of the costs?
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Will they cover routine prenatal care?
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Will they cover prenatal tests, including
ultrasound, amniocentesis, blood work, etc.?
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Will they cover prescription medications?
Prenatal vitamins? Is there a co-pay?
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What steps do you have to take to inform
them of the birth? And to enroll baby in insurance program. (Baby must
be enrolled within 30 days after birth.)
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Will they cover childbirth classes? Will
they cover doula services? Most don’t, but it’s worth asking to be sure.
(And to let them know that consumer demand exists for this coverage!)
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Will they cover pain medication and
anesthetist’s fees?
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How long can your postpartum hospital stay
be? (Under the Newborns' and Mothers' Health Protection Act, if a plan
covers maternity or newborn benefits, it must allow mothers and newborns
a 48-hour hospital stay after a vaginal birth and 96 hours if a cesarean
section has been performed,)
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What newborn care will they cover? Routine
care, special care nursery, circumcision?
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Will they cover lactation consultants to
help you get breastfeeding off to a great start?
Switching health insurance during pregnancy.
HIPAA, the Health
Insurance Portability and Accountability Act, may ensure that if you
switch from one group health insurance plan to a new group plan during your
pregnancy, they cannot consider pregnancy a pre-existing condition, and deny
you coverage.
However, if they have a
generalized waiting period between when someone enrolls, and when coverage
begins, that waiting period could apply to you.
If you previously had no
health insurance, or had individual insurance, and then you enroll in a
group plan, you may have a waiting period before your insurance will cover
pregnancy-related costs. Trying to buy individual group coverage when
pregnant may be challenging, and may be very expensive.
Government assistance
options
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Medicaid. You may be eligible for Medicaid
if your family income is at or below 133% of the poverty level. (e.g.
approximately $21,000 per year for a married woman and husband, pregnant
with their first child) Some states are more generous in their
coverage, and allow Medicaid for families up to 185% of poverty level
(approximately $29,000) Get an application from your local
Medicaid office. Look in the blue pages of the phone book, under
“medical assistance”. If you have trouble finding it, try calling your
local Social Security office; they can give you the phone number and
address. You can look online at
www.cms.hhs.gov/medicaid/ for more information, including state
eligibility guidelines and phone numbers of local offices.
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WIC - Supplemental Nutrition Program for
Women, Infants, and Children. Provides nutrition counseling and access
to heath care services to low-income women who are pregnant, or
postpartum, and to infants and children up to 5 years of age. To
qualify, the household income must be below 185% of the poverty line,
and may need to meet additional requirements. Information available at
www.fns.usda.gov/wic/
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Other assistance. Some low income women
may also qualify for TANF (temporary assistance for needy families), for
SSI disability income, and/or for food stamps. Contact your local social
security office for more information.
Other options for insurance:
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Will your boyfriend’s / partner’s
insurance cover your pregnancy? Some will, but many won’t. (Once the
baby is born, an unmarried partner should be able to add the baby to
his/her health plan if paternity is demonstrated, or if s/he adopts the
baby.)
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Contact your state insurance department
for more information on how to cover your pregnancy and ask what other
types of low-cost insurance plans they offer.
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If you have recently left a job, or
recently divorced, ask about applying for COBRA to cover your pregnancy
if you are between plans. COBRA is a federal law that provides health
insurance for qualified workers, their spouses and their dependent
children if they are between plans.
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You may qualify for a group health plan
through a union or professional organization, and this may be more
affordable than purchasing individual insurance.
If you do need to pay out of pocket
Call the hospital's patient account office, and do your research in advance
to learn what you’ll be facing.
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Ask about the charge for a vaginal
delivery with a one-day stay.
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Ask about the charge for cesarean birth
with a three-day stay.
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Ask about the costs of pain medication for
labor and birth, or for cesarean.
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Find out if you will be charged for
nursery care for the baby, even if baby rooms in with you. What if your
infant needs any special care?
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Can you pre-pay the costs?
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If you pre-pay for epidural (about $1200),
be sure that money will be refunded if you do not use it in labor.
After the birth
Contact your health plan
within 30 days of your child's birth, adoption or placement for adoption and
request a special enrollment to cover the event.
This article is posted with permission from
www.greatstarts.org,
Great Starts Birth and Family Education. Be sure to visit their website.
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