What Every Hopeful Parent Needs to Know About Maternity Coverage

December 04, 2012

So what’s stopping you? It could be that you know very little about maternity coverage. Is it included in your coverage through work? Can you get it on an individual or family policy? How much does a baby cost? These are all great questions and ones we will take a closer look at right now.

The Cost (Without Insurance)

The average cost of an uncomplicated cesarean section has more than doubled from 1993-2007, and the cost of an uncomplicated vaginal delivery has almost tripled during that same time period.

From 2008-2010 the average cost for a vaginal delivery with no complications has increased from $8,919 to $10,166. Compared to $20,074 to $23,111 for a cesarean delivery with complications during the same time span. According to hcupnet.gov.

As you can see, the cost associated with having a baby is significant, even more so depending on the type of delivery. That's just so they can leave the womb. Now if only the sold "kids wanting and needing stuff" insurance.

Group Coverage

If you receive your health insurance through work, you already have maternity coverage. By law, all employer sponsored health insurance plans must provide coverage for maternity. Having such a benefit will greatly reduce your total out-of-pocket costs. In most cases, you will just have to meet your annual deductible and coinsurance limit. Once you have satisfied both of those amounts your insurance company should pay for all, in-network, medical treatment received that year. That means you have the green light to start having babies as often as you want, whenever you want.

Individual Coverage

If you are self-employed or have a job that doesn’t offer health insurance, you are more than likely covered under an individual or family health insurance plan. If not, what are you doing? These plans don’t include coverage for maternity, unless purchased separately. Most health insurance companies will limit the number of plans that you can add maternity to. That means, if your current plan is not eligible for maternity, you could face buying a more expensive plan on top of paying extra for that coverage.

Waiting Periods

If you opt to purchase the separate maternity rider for your individual policy, it must be in effect at least six months before the pregnancy begins. Basicly, you need to have this coverage in place well before you and your spouse pull the goalie. You will also be required to reapply for your health insurance policy to add the coverage. Remember: It’s very important that the coverage is in place before even think about giving your spouse that procreation look.

Separate Deductible

It’s also important to know that in addition to your regular calendar year deductible, most companies require you to satisfy a separate maternity deductible, if you purchased the separate ride on your individual policy. This deductible could be anywhere from $1,000 - $3,000.

Health Care Reform

Starting on January 1, 2014, maternity coverage is included as one of the 10 essential health benefits all individual and group plans must cover, according to healthcare.gov. That means you will no longer be required to add a separate maternity rider to have coverage. However, the details of this coverage have not been released, so it’s still possible your individual or family plan could require you to satisfy a separate maternity deductible.

The Bottom Line

If you have maternity coverage through your group health insurance plan, it’s a no brainer. Production at your baby factory is a go. However, if you have individual coverage, you might want to consider delaying your family plans another year to see if the changes health care reform bring can save you a substantial amount of money.

Are you and your spouse ready to have a baby? Do you have maternity coverage?