Is there such thing as private health insurance with maternity coverage?

The good news for women of childbearing age is that there is such a thing as private medical insurance with maternity coverage. The bad news is that the cost of such insurance could be significantly higher than a plan that doesn’t offer it.

However, in the long run, a health insurance company that covers your maternity costs could save you money. Whether or not an employer-sponsored plan includes maternity coverage is usually up to each individual employer.

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According to numbers from the U.S. Bureau of Labor and Statistics, 66% of all private health care plans included some sort of maternity coverage. Most plans were subject to very specific coverage limits while only 10% of them covered maternity costs in full. So even among those mothers who do have maternity coverage, some out of pocket expenses are inevitable.

High Cost of Maternity Care

Why is the cost of maternity care so high?   There is much debate within government institutions and the insurance industry as to why coverage for maternity care is so expensive. One thing that everyone can agree on is the fact that the cost of doctor visits, labor and delivery, and hospitalization are all going up faster than the rate of inflation.

When the price of medical services goes up, the cost of health insurance premiums will follow accordingly.

Some would argue that the overuse of preventative care is adding substantially to the cost of maternity health insurance. For example, it’s now routine for a woman to have several sonograms throughout her nine month pregnancy. Each one of those sonograms adds to the total cost of care; a cost that was substantially lower before the use of sonograms became so widespread. Those who argue this point claim that our attempts to remove all the risks from pregnancy are unnecessarily causing inflation in the cost of maternity coverage.

Some States Mandate Maternity Coverage

Do any states mandate maternity coverage for private health insurance?   There is a growing effort among state legislatures to mandate that health insurance companies provide maternity health insurance to all women of childbearing age. Several attempts to do just that have been made throughout the country over the last decade. According to the Kaiser Family Foundation there are 17 states that currently mandate some sort of maternity coverage.

It’s important to note that some states only require certain types of insurance policies to offer maternity coverage. For example, the Alabama and California laws only apply to HMOs; major medical and other types of plans are exempt. On the other hand, Montana requires all insurance policies to provide maternity coverage regardless of how they’re structured. Other states have varying mandates that apply according to the group size, policy type, and so on.

You can find out what your state requires by contacting your state insurance department or your private health insurance provider.

Expectant Mothers Without Health Insurance

What about expectant mothers without health insurance?  When an expectant mother first sees her obstetrician or goes to a public clinic, she will typically be asked about health insurance coverage. If she does not have insurance she will almost always be encouraged to apply for Medicaid health insurance. Medicaid is the government health insurance plan designed to cover individuals whose income is low enough to prevent them from purchasing private health insurance.

If the mother’s income is too high to qualify for Medicaid she might be eligible for a subsidized insurance plan offered by her state. Otherwise, the only other options are to purchase a private health insurance plan with maternity coverage or pay for her maternity care of her own pocket. Mothers who choose the latter option need not necessarily have all of the money up front.

For example, New York is one of a handful of states that requires medical facilities to work with uninsured patients to set up payment plans. If you live in one of these states your obstetrician and hospital or clinic must allow you to pay your bill monthly if you have no insurance. In New York specifically, doctors and healthcare facilities cannot require monthly payments that exceed 10% of your monthly income. In many cases healthcare providers voluntarily offer discount rates to uninsured individuals with slightly lower income.

It goes without saying that the cost of having a baby is pretty high. If you’re a woman of childbearing age it is in your best interests to seek out a private health insurance plan that includes maternity coverage. If that’s not possible you have the option of applying for Medicaid or state subsidized insurance.

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