Pregnancy can feel like it comes with a million different choices to consider, plans to make, and obstacles to overcome. Bringing an entire new human being into the world is already an overwhelming feat.
As if it wasn’t already enough to handle, The Peterson-KFF Health System Tracker puts the average cost of pregnancy, childbirth, and post-partum care in the U.S. at nearly $19,000—and that’s for people with insurance. Luckily, insurance covers most of that cost. The average out-of-pocket cost (the part the patient pays) is closer to $3,000.
When embarking on something you know will have such a high cost, taking care to find the right health care plan is just smart.
First, some good news:
All health care plans that are compatible with the ACA (Affordable Care Act) are required to cover maternity services including pregnancy, childbirth, and newborn care. That includes any plans you see on the healthcare insurance marketplace. And it’s true even if you’re already pregnant when you sign up.
And now, a caveat:
You can’t sign up for an ACA-compliant plan whenever it’s convenient for you. You have to do so either during open enrollment (Nov 1 - Jan 16) or a special enrollment period that is triggered in response to a life event including being offered a new health plan, like the one StretchDollar offers.
Getting pregnant doesn’t count as a life event. Having a child does. But, you don’t want to wait until your child’s birth to sign up for health insurance if you can help it—that would leave you on your own paying for pregnancy and labor.
What to consider in your health insurance search
A lot of the general advice for finding the right health insurance plan applies here, so consider taking a few minutes to read through our general guide first. But there are a few unique tips and considerations to factor into your search when a pregnancy is likely to be in your future (or your present).
1. Think through what you want your pregnancy and birth to look like.
When it comes to pregnancy, labor, and post-natal care, there’s a lot you can’t plan for. But thinking through what your best-case scenario looks like can help you plan for as much as possible. Consider what you’ll likely need and want for each stage of the process:
- Pre-pregnancy - If you’re already pregnant, you don’t have to worry about this stage. If you’re trying to get pregnant, you may want to consider the potential need for fertility treatments. Many insurance plans don’t cover fertility care like IVF (in-vitro fertilization) and the cost is significant. If you can find a plan that does, it could save you thousands of dollars.
- During pregnancy - While pregnant, you’ll need regular health screenings, prenatal supplements, lab work, ultrasounds, and birthing classes. Most plans are required to cover these services, but you want to be careful to use in-network providers if you’re not prepared to handle the cost on your own.
- Labor - If you want to use a birthing center, pregnancy doula, midwife, and/or have an at-home birth, the overall costs may be less than at a hospital, but insurance is unlikely to cover them. Within a hospital, choosing a vaginal birth generally costs less than a c-section (although sometimes the latter will be required, even if it’s not what you plan for).
- Postpartum - After the birth, your newborn will require their own healthcare (which you’ll want to get set up ASAP). But the birthing parent will also need further care to help your body recover from labor and to potentially address a postpartum mood disorder, if one arises. If you choose to breastfeed, you may also want help with lactation, so consider checking which insurance plans cover a lactation consultant.
2. List out any must-haves.
Thinking through your pregnancy and birth plan will help you clarify some of your needs. Determine anything in your care plan that you’d consider a “must-have,” such as:
- A particular ob-gyn you love, as well as any other specific doctors you want to keep seeing
- A hospital you definitely want to use throughout your pregnancy and labor
- Any type of care or procedure that’s important to you
- Any prescriptions (including those not related to pregnancy) you need
Identifying the main things you don’t want to budge on will help guide your research.
3. Check which plans have your “must-haves” in-network.
Now, start the process of evaluating specific health care plans. If your employer uses StretchDollar, you can easily view and compare available marketplace plans or reach out to one of their licensed health insurance brokers for guidance. If not, check out Healthcare.gov or your state-based exchange. For each plan you consider, make sure your must-haves are covered and in network. If you can’t find an insurance plan that includes everything you want, you’ll at least be able to amend your birth plan in advance based on what is available to you.
4. Prioritize a low deductible over a low premium.
It’s often tempting to choose a low monthly cost when selecting health care plans. But when you know an intensive health condition that requires a lot of care is in the cards, that’s not the time to trade lower premiums for a high deductible. Pregnancy, labor, and post-pregnancy care are all expensive. If your deductible is high, a lot of that cost will be on your shoulders before insurance kicks in to pay their part.
In addition to the premium and deductible amounts, also pay attention to the plan’s copay and coinsurance details. The copay is how much you’ll have to pay upfront for each doctor’s visit, treatment, and medication (and you’re likely to have a lot of those during your pregnancy). Co-insurance is the percentage the plan covers for all the in-network services you use.
5. Review the SBC (Summary Benefits & Coverage) for each plan.
Every ACA-compliant health insurance plan is required to provide an SBC, a document that helps spell out what your benefits include and what your costs are likely to be for different services. Each SBC includes a section for Coverage Examples, which will offer information on common medical events like pregnancy. The SBC won’t give you specific numbers on what your pregnancy will cost, but it can give you an idea of what to expect and make it easier to compare different plans.
6. Call to reconfirm your ob-gyn and hospital is in network.
Unfortunately, health insurance provider directories are often out of date. It means the best way to confirm if your ob/gyn, hospital and any other physicians you want to see are in network is to contact the doctor offices directly. The bit extra work will help to prevent hassle and stress later on.
Summary and a reminder.
Your coverage will not start until you’ve made a premium payment, which will go directly to the carrier you chose (even if you’re purchasing insurance on the marketplace). For StretchDollar customers, that first invoice is important for unlocking your premium health benefit. Make sure to keep on top of the monthly payments to keep your coverage running smoothly.
The right health insurance plan won’t make having a baby easy, but it can ease some of the financial costs involved. When you’re facing the costs of diapers, formula, and (eventually) childcare, you’ll be grateful for those savings. Take the time upfront to find the best plan available to you. You’ll be glad you did.
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