5 Things to Know About Health Insurance If You're Planning for a Baby
by Christy Bieber | Updated July 17, 2021 - First published on Sept. 2, 2019
Are you planning to try to get pregnant? Here are some key things to know about health insurance first.
If you're thinking about growing your family, it's important to realize that this can come with a whole host of additional medical expenses.
You'll want to be sure to understand which of these expenses health insurance covers so you can estimate your out-of-pocket costs. And if you have the chance, you may even want to explore whether your current insurance coverage is actually the right policy for you.
Researching health insurance when planning for a baby could save you a fortune in the long run, or at least allow you to budget for big expenses so you don't end up reaching for the credit cards and accruing a lot of debt during the process. If you're not sure where to start in looking into coverage or costs, here are five things that you need to know about health insurance so you can prepare.
1. Most insurance policies have to provide at least some coverage for prenatal care
The good news if you're thinking about getting pregnant is that health insurers are typically required by law to help you cover at least some pregnancy costs. That's because the Affordable Care Act made coverage for maternity care an essential health benefit that all qualifying health insurance plans have to provide.
Pregnancy is also considered a pre-existing condition, and the ACA prohibits discrimination on the basis of existing medical issues. That means if you aren't signed up for coverage or you want to change insurance policies, an insurer will have to cover you (provided you sign up during open enrollment or another eligible enrollment period).
If you have short-term insurance or a plan grandfathered in from before the ACA passed, however, you may not have coverage for any of your prenatal visits, as these plans aren't subject to the mandate to cover maternity care. You may wish to switch policies during open enrollment to one that offers broader coverage if you know you'll try to get pregnant soon.
Open enrollment also provides the perfect time for everyone to compare policies. If you know you'll be having a baby soon, you may decide to upgrade your current plan to one with a lower deductible or more comprehensive coverage -- even if the premiums are higher. Switching plans could be worth it when pregnancy is imminent so you can get your insurer to cover as much as possible.
2. Coverage for infertility treatment may be very limited
Approximately one in 10 women in the United States struggle with infertility, according to The Office on Women's Health. If you are one of them, you'll want to check your insurance coverage very carefully to see what infertility coverage -- if any -- is available.
Many insurance policies provide very limited coverage for fertility treatments, or provide no coverage at all. If this is the case, you could be looking at paying tens of thousands of dollars out of pocket for the care you need to get pregnant. You may need to take out a personal loan to finance your fertility treatments, or you can consider working with a clinic that provides financing or offers a shared-risk program.
3. Out-of-network care could be much costlier
While your insurance likely offers coverage for maternity care, chances are good you'll be required to go to an in-network care provider to ensure you don't face any big medical bills.
In-network doctors participate with your insurer and have agreed to accept the rates your insurer pays for services. If you go to an out-of-network provider, you may have a different -- and higher -- deductible to meet, or your insurer may provide no coverage at all. The provider may also charge more than your insurance company is willing to pay for a particular medical service, which could make you responsible for paying the difference.
Unfortunately, it's common for pregnant women to be surprised with out-of-network care charges. This could happen, for example, because one provider at the hospital where she gives birth is out of network or because a lab that processes some blood work isn't in the network.
Make sure you pick a care provider that does participate with your insurer, and let your doctor and the hospital know that you want to stick with receiving treatments from in-network medical professionals whenever it is possible to do so.
4. You may face big costs for the birth
Giving birth causes financial distress for lots of families because the costs associated with delivery are often pretty high.
It's common for health insurance policies to charge substantial coinsurance costs for hospital stays. While giving birth in a birthing center or at home with the help of a midwife can be much cheaper, some insurers won't pay for out-of-hospital births at all.
Read your insurance policy carefully to find out what percentage of hospital costs you'll be expected to incur or to learn whether the natural out-of-hospital birth you may be dreaming of will have to be paid for out-of-pocket. Then start saving money for these expenses if you are going to get stuck paying them.
5. Your baby probably has a separate deductible
When your baby is born, you may assume he or she will just get necessary care as part of your birthing costs. But this isn't necessarily the case.
Babies are separate people from their mom or dad, so many insurers require them to meet their own deductible before their care is covered. If your baby needs medical interventions after birth, you may have to pay the deductible first before your insurance starts covering some of the bills.
Make sure you understand how your health insurance will cover your costs
The above five things are key to keep in mind when reviewing your health insurance policy before getting pregnant or when shopping for coverage if you're planning on growing your family.
You can prepare in advance for the financial impact of pregnancy, and can take steps before conceiving -- such as shopping for comprehensive insurance -- to make sure your costs are as low as possible. Kids are expensive, so you'll want to hold onto your cash for when the baby actually comes. It'll be well worth your effort.
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