All Costs Considered: Pregnancy, Childbirth and Health Insurance

Fran
Fran Majidi
July 28, 2020

Coronavirus may be keeping people at home, but couples are still planning families. Prenatal care and pregnancy require medical attention to ensure a safe and healthy delivery.

It’s important that you know how you’re going to pay for doctor visits and delivery room charges. Without health insurance an average delivery of a baby costs $10,808, and as much as $30,000 if you factor in prenatal and postnatal care.

Even though the Affordable Care Act requires that pregnancy, labor, delivery and care of a newborn be mandatory coverages, not everyone has insurance. Also consider that over one million mothers had a c-section in 2017. C-sections are not only more costly, but they often carry risks that may prolong a hospital stay and increase an already exorbitant bill. In California, for example, a c-section without insurance cost an average of nearly $20,000.

Note that being pregnant does not mean that you are eligible for health insurance any time. The birth of a child, however, is a qualifying event which enables you to buy insurance outside the regular Open Enrollment dates for health insurance. You have a 60-day window to enroll in a new plan after the birth of a child.

More about that later. Let’s get started with the basics first.

When Is Open Enrollment?

Open Enrollment period is usually from October through mid-December. Plans become effective January 1.

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How Much Does Pregnancy Cost?

The answer to this question depends entirely on the expectant mom. There is a big range in prices depending on your location and where and how you give birth. Without health insurance, however, a hospital birth can cost tens of thousands of dollars. In California, around $14,000 without c-Section, close to $20,000 with a c-section

Buying health insurance before or as soon as you find out you are pregnant is crucial to avoiding medical bankruptcy. Comparing health insurance plan rates is very important too, if you want to pay the least. But to do so, you must first consider how often you’ll be seeing a doctor, how much in copays you’ll be paying each and how many specialists you’ll need to see. These factors are important because you may end up paying less in medical costs overall by paying a higher premium. Generally speaking, HMOs have the least out-of-pocket expenses. But it’s important for you to speak with a trusted agent about all your options before you choose a plan.

Do All Health Insurance Plans Cover Pregnancy?

All health insurance marketplace plans and Medicaid plans cover pregnancy and childbirth. After you have the baby, you can switch plans again, even if it’s outside the Open Enrollment Period. If you’ve already given birth and are uninsured, you can shop and compare quotes for health insurance outside the Open Enrollment Period.

Maternity care and childbirth are essential benefits that all Marketplace plans and private plans must offer. You are covered even if you were pregnant before coverage began.

Beware, however, some grandfathered private insurance plans do not cover pregnancy and childbirth. You may also not be covered if you’re insured on your parents plan. If this is your situation, it’s a good idea to buy health insurance separately.

What Is Prenatal Care and Am I Covered?

Prenatal care is medical care you get during pregnancy. You will likely be covered by your medical insurance. You may have a copay. A copay is a small portion of the bill, which can range from $25 to $95 depending on your plan and if you’re seeing a specialist.

It’s important to get prenatal care. Babies who do not receive it are three times more likely to be underweight and five times more likely to die. Complications with a pregnancy can also be detected during prenatal care. The earlier a problem is spotted, the easier it is for a doctor to solve it.

Prenatal care is just as important for experienced mothers as it is for new moms. It doesn’t matter if it’s your first pregnancy or your third or fourth. It’s important to get the right vitamins and discuss any medications you may be taking with your doctor. Getting a flu shot is also highly advised and so is avoiding x-rays.

Also, be prepared to get some push back if you are on your parents’ health insurance plan and become pregnant. Some carriers will not cover maternity costs for adult dependents of a policyholder.

Which Services Are Usually Covered for Expecting Mothers and Babies?

  • Prenatal visits
  • Postnatal visits
  • Gestational diabetes screening (often a risk during pregnancy)
  • Lab work
  • Newborn care
  • Lactation counseling
  • Breast pump rental

I’m Pregnant Now, Do I Qualify for Insurance?

Unfortunately, you’ll have to wait until the child is born to get insurance outside of Open Enrollment, unless you have another qualifying event, like losing a job or moving. Here’s much more on qualifying events that make you eligible for a Special Enrollment Period.

I May Be Pregnant but I’m Not Sure

It’s important to see a doctor as soon as you suspect that you are pregnant. The sooner you begin prenatal care, the better. Below you’ll find some common symptoms of pregnancy. However, it’s important that you take a test and/or see your doctor. Even if you’re not pregnant, some of these symptoms may point to other serious complications.

  • Missed period
  • Hair loss
  • Nipple discharge
  • Vision changes
  • Sudden facial hair
  • Pelvic pain
  • Breast tenderness
  • Fatigue
  • Nausea
  • Frequent urination
  • Darkening areolas
  • Cervical mucus

I’m Ready to Buy Health Insurance But How Does it Work?

The plan options will be available in different tiers, which range from bronze to platinum. The more expensive it is each month, the less you pay out of pocket. Here’s everything you need to know about buying health insurance.

When you’re done, just enter your zip code below, and we’ll find you the lowest rates.

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