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Pregnancy Insurance: A Little Background

 Whether you are already pregnant, plan on getting pregnant soon, or are planning to get pregnant in years to come, it is important you understand how pregnancy insurance works and what it covers. You can then be prepared and have one less thing on your mind when you decide to bring a little bundle of joy into the world. Here is a little background to help you understand the basics of pregnancy insurance.



The Cost of Childbirth


The cost of having a baby in the US is pretty high. On average, expenses range between $10,808 and $30,000. The precise cost is determined by your delivery method, the extent of any prenatal and postnatal complications, and the state in which you live. Check out this article to discover the childbirth costs where you live. Furthermore, the cost of childbirth depends on your insurance policy. For example, in Arizona, a vaginal birth costs $8,034 with insurance and $14,812 without insurance; and if you have a cesarean section, the cost in Arizona is $10,699 with insurance and $18,023 without. As you can see, having insurance significantly lowers the cost.


The Good News


The good news is all of today’s major medical insurance plans include coverage for pregnancy, including family plans, individual plans, and group plans. That was only made possible after the Affordable Care Act was implemented in 2014. Before then, maternity coverage was not a guaranteed benefit of insurance plans. In fact, according to the National Women’s Law Center, only 12% of individual insurance plans listed pregnancy as a covered benefit; and only nine states required maternity coverage prior to 2014. 


What Pregnancy Insurance Covers


Under the Affordable Care Act, health insurance for pregnant women includes costs for pregnancy, delivery, and newborn care. But the precise coverage you get can vary depending on your specific insurance plan and how your insurer chooses to cover the mandatory elements. Furthermore, your out-of-pocket costs can differ depending on factors like the tier of coverage you have, your deductibles, your copayments, and the insurance company you choose to go with; which is why it is always a good idea to compare different insurers before you sign on the dotted line. However, all insurance plans cover the basics of:

  • Outpatient services, which include prenatal and postnatal doctor visits, medications, and things like gestational diabetes screenings and lab studies.

  • Inpatient services, which include things like hospitalization and physician fees.

  • Newborn baby care.

  • Lactation counseling and devices like breast pumps.


How to Know What Specific Benefits Are Included


It is important you closely examine any insurance policy before you engage with a contract. It is easy to do that for pregnancy insurance because all health plans are required to provide a Summary of Benefits and Coverage. The summary details exactly what is covered for pregnancy and childbirth. By comparing the summaries of different insurance providers, you can get the right policy for your needs and not be left with any surprise medical bills later on when you realize you are not covered for a specific benefit. 


When to Enroll


The annual open enrollment period for health insurance coverage runs from November 1 to December 15 in the majority of states; although some states provide extended open enrollment. Outside of the designated enrollment period, you cannot enroll or switch health insurance plans, unless you experience a qualifying life event. With qualifying life events, a special enrollment period is triggered, which usually lasts around sixty days. Giving birth is counted as a qualifying life event, but getting pregnant is not. 



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