Do we have the right health insurance?
Why is health insurance important?
Having the right insurance can be important at any point in life, but it's extra important when you're pregnant. The average cost of giving birth in the US is $18,865, covering pregnancy, delivery, and postpartum care. The total cost varies based on your location, the type of birth (vaginal or cesarean), and any complications that may arise.
Health insurance can ensure that you and your baby receive the necessary care without significant financial obstacles.
Identifying what kind of coverage you’ll want
Talk to your healthcare provider to get a comprehensive view into their recommended care. They've been through this countless times with other couples, so they have a wealth of knowledge about what kind of care you'll need throughout your pregnancy, delivery, and even after your baby is born.
Your healthcare provider can discuss any preexisting conditions and family medical history and give you a rundown of the essential prenatal checkups, tests, and scans that will help ensure a healthy pregnancy.
They can also provide insight into what to expect during labor and delivery, including pain management options and potential complications that may require additional care.
Don't be shy about asking them what's typically covered by insurance and what might come with some out-of-pocket costs.
Understanding your current coverage
Once you have a clear picture of your healthcare needs, review your insurance plan’s maternity coverage. Compare what your provider mentioned is usually covered with what your plan actually offers.
Check for information on deductibles, copayments, and coinsurance. These are the amounts you'll need to pay before your insurance starts covering expenses. Knowing these figures will help you budget effectively and avoid unexpected costs.
If you find any gaps or discrepancies, now is the time to address them.
A basic rule of thumb is to choose a health insurance policy with a higher premium and lower deductible when you're pregnant. Your monthly premiums will be higher, but you'll hit your deductible sooner rather than later since the cost of birth is so high in the US, saving money over the long term since your insurance will step in after you hit your deductible.
Knowing common health insurance terms
- Premium: The monthly fee you pay your insurance provider for coverage.
- In-network: The network of facilities, providers and suppliers with whom your insurance provider has pre-negotiated preferred rates. You will generally have the lowest costs when you get care in your plan’s network.
- Out-of-network: Facilities, providers, and suppliers that aren't part of your health plan's network.
- Out-of-pocket costs: Medical care costs not covered by your insurance plan that you need to pay in full yourself.
- Covered: Plans typically covers most doctor and hospital visits, prescription drugs, wellness care, and medical devices. Most plans don't cover elective or cosmetic procedures, beauty treatments, off-label drug use, or brand-new technologies. Your provider can be in network, but the service you receive can still not be covered.
- Deductible: The amount you pay for covered services before your health insurance kicks in; for example, if your deductible is $2,000, you’ll need to reach that amount out of pocket before your insurance takes over.
- Copay: A fixed amount fee you pay for a covered healthcare service.
- Coinsurance: The percentage of costs you pay for covered services after you've met your deductible.
- Out-of-pocket maximum: The most you have to pay for covered services in a plan year.
- Dependent: A person who is eligible to be added to a policyholder's health insurance coverage.
- Prior authorization: Approval from a health plan required before you get a service or fill a prescription.
- Explanation of Benefits (EOB): A statement sent by your health insurance company explaining what medical treatments and/or services were paid for on your behalf.
- Health Savings Account (HSA): A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.
- Flexible Spending Account (FSA): An arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars.
- Open enrollment: The yearly period when people can enroll in a health insurance plan.
- Preexisting condition: A health problem you had before the date that new health coverage starts.
Evaluating your provider network
It’s important to ensure that your preferred healthcare providers, including your doctor or midwife and pediatrician, are in-network with your insurance plan. Choosing in-network providers can save you a lot of money and hassle during your pregnancy and after your baby arrives.
When looking at your provider network, consider the location and accessibility of in-network hospitals and birthing centers. You want to choose a place that’s convenient, especially when it’s time to give birth.
While it’s best to stick with in-network providers, knowing the costs and coverage for out-of-network providers is also helpful. This information can be crucial in emergencies or if you have a specific provider in mind. Review your insurance plan’s out-of-network coverage, as costs can vary greatly compared to in-network services.
Planning for the baby's coverage
Most insurance plans automatically cover your baby for the first 30 days after birth. During this time, any medical expenses, like routine check-ups or unexpected hospital visits, will be covered under the mother’s plan. However, you may need to enroll your baby within a specific timeframe to ensure coverage continues beyond those 30 days. Don’t wait until the last minute to do this to avoid gaps in coverage.
While pregnancy isn’t considered a qualifying event, having a child is. This means you can enroll in a new plan after giving birth.
If you have separate health insurance plans and decide to enroll your baby in both, remember that primary care coverage will depend on which parent's birthday comes first in the year. Be careful not to accidentally change one plan while the other becomes the primary coverage.
Adding your baby to your existing plan is usually the most convenient and cost-effective option, especially if you have a family plan that already covers multiple people.
However, you may want to consider looking into separate child health insurance policies if you have an individual plan or if adding your baby to your current plan would raise your premiums significantly. Take the time to compare costs and benefits to find the best option for your family’s needs and budget.
Including postpartum care
Look into your coverage for postpartum visits with your healthcare provider, including length of your postpartum coverage and any limitations on the number of visits or services. It's important to ensure you have access to the necessary care for as long as you need it to support a smooth and healthy recovery.
In addition, check if your plan includes mental health support and pelvic floor therapy. Many postpartum visits will include a screening for postpartum depression, and pelvic floor therapy can be crucial if you're experiencing any physical discomfort or issues after childbirth.
Investigating additional benefits
Some plans offer extra benefits like coverage for prenatal classes or lactation support, which can be very helpful for new moms learning about breastfeeding. Many also cover breastfeeding equipment and supplies. These additional resources can provide valuable support during and after your pregnancy, so be sure to look for them.
Keeping an eye out for restrictions
Be aware of any limitations or exclusions that could affect your coverage. Some plans may have restrictions on certain services or require you to use specific healthcare providers. Understanding these details ahead of time can help you plan better and avoid surprises.
Understanding alternative options
If you're self-employed, work part-time, or don't have employer-sponsored health insurance, consider options like Medicaid, the Children's Health Insurance Program (CHIP), or individual health insurance plans available through the marketplace.
The Health Insurance Marketplace, also known as the "marketplace" or "exchange," allows you to view and compare healthcare plans available under the Affordable Care Act. In most states, the federal government runs this marketplace for individuals and families.
You can also visit Planned Parenthood or federally qualified health centers that offer prenatal care based on income. These facilities provide comprehensive pregnancy care and support to ensure your and your baby's health, regardless of your financial situation.
Seeking help & asking questions
Take the time to review your plan carefully, and don’t hesitate to reach out to your insurance provider if you have questions. Their customer service representatives can help you understand what’s covered, what isn’t, and any out-of-pocket costs you might face. If the insurance terms are confusing, consider getting help from a patient advocate who can assist you in navigating health insurance.
Local community organizations, such as women’s health clinics or family resource centers, may also offer guidance, support, or even financial assistance to help you with the insurance process and prepare for your new baby.
Planning for the future
While your primary focus may be on pregnancy and childbirth, think about your family’s long-term healthcare needs. Look for plans that will offer comprehensive coverage as your family grows.
By being proactive and informed, you can confidently enter this exciting new chapter, knowing you and your baby have access to the care you need.
Remember, having the right health insurance can give you peace of mind and financial protection during this special time. Take the time to discuss your options, ask questions, and make a decision that suits your growing family best.
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