What Does Maternity Insurance Cost and Do You Need It?


What Does Maternity Insurance Cost and Do You Need It?


Planning on having a baby? From an insurance standpoint, you’d better plan at least a year in advance because many group and most individual health insurance plans consider pregnancy to be a pre-existing condition.  That means you’ll probably be subject to a waiting period before your coverage kicks in if you or your covered spouse is pregnant when you apply for health insurance.  


While some health insurance plans include maternity insurance coverage as a standard benefit, many others only offer it as an optional rider. Some plans offer the maternity insurance rider with no waiting period, but the benefits may be smaller during the first two years that the plan is in effect. Exactly how much maternity insurance costs will depend on your plan, but even a high-cost plan will help off-set the high price of having a baby. Pre-natal care and a normal hospital delivery can be as much as $12,000; if you have complications during your pregnancy or delivery, it will only go up from there.


What Does Maternity Insurance Cover?

Here again, what is covered by maternity insurance will depend on your health care plan. Typically benefits include prenatal doctor visits, prenatal testing like amniocentesis, ultrasound and sonograms, lab work, hospitalization, delivery and neonatal care. Some plans require that certain services be pre-authorized before your maternity insurance will cover the cost.


When looking for maternity insurance quotes, you should learn if the plan covers well-baby care and how long it will pay for hospitalization beyond the minimum stay required by federal and your state’s laws.


Most states have dependent children laws that require that your health insurance provide coverage for newborns for the first 31 days following birth. Beyond that, you need to find out what you must do to make sure that you newborn is covered.


Other questions to ask when looking for maternity insurance include:

  • Will you need to contact your insurance provider when you’re admitted to the hospital for delivery?
  • What are the rules about in-network and out-of-network healthcare providers and hospitals?
  • If you are in an HMO, will you need a referral from your primary care physician to see an obstetrician?
  • If you prefer to deliver at home or at a birth center using a midwife or certified nurse, will your maternity insurance pay for it?


Things to note:

  • HIPAA places limits on the amount of time any insurance company can currently apply a pre-existing condition exclusion.
  • Federal and state programs like Medicare, Medicaid and COBRA, and HIPAA laws also can provide maternity coverage assistance if you are pregnant.

If the Health Care Reform Act (aka ObamaCare) is not significantly changed or repealed, all insurance company restrictions regarding all pre-existing conditions will disappear in 2014.

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