Thirteen percent of American women who become pregnant lack maternity and pre-natal health carexcoverage. They face the risk of inadequate pre-natal care and must find their own resources for funding the cost. If the pregnancy is complicated, this adds to the burden.

Women with a Health Care Plan may not have coverage for maternity. Maternity coverage is a costly additional feature that isn’t always provided with an employer group plan and is often lacking in many of the more economically priced Individual / Family plans available. Most Health Care Coverage providers and Health Insurance carriers do not allow a maternity benefit to be added once a woman has already become pregnant. Furthermore, in most states, a prospective father is not eligible for a new health care plan until the baby is born because the newborn is automatically covered by the parent’s policy for an initial period from moment of birth.

Many employer group health care plans provide maternity coverage, but there is often a waiting period of three months to one year before the maternity provision becomes effective. What happens if one becomes pregnant during the waiting period? If you are carrying COBRA (extended coverage from a previous employer), check to see if maternity is covered. This may be costly but well worth it.

Some states have plans for pregnant women who lack a health care plan with a maternity benefit such as the AIM program (Access for Infants and Mothers) in California. Other federally sponsored and state administered programs also exist, but they are mostly for low-income to medium income groups. Under the AIM program a pregnant mother can obtain coverage as late as the sixth month. The cost of the maternity coverage is determined according to income level. Even women who have a health care plan are eligible as long as the plan does not have a maternity benefit.

What does a Maternity benefit actually cover?

It is important to understand what the Maternity benefit offered with a health care plan actually covers. In most cases, maternity benefits refer to pre-natal care, normal child birth delivery services of the OB/Gyn, and related hospital room and services including one night stay after childbirth. Most state laws mandate the minimal coverage that must be provided if a maternity benefit is included in a policy. In most cases state law mandates that any complication of a pregnancy, on the part of the mother, is covered and is treated as though it were a separate hospitalization and separate surgery. It is likely that the cost of the caesarean, for example, will be covered like any other in-patient hospital procedure. Most states mandate that the infant is covered from the moment of birth for a specified number of days (probably 30) so the expenses associated with the newborn are not typically a part of the maternity benefit.

What are the economics of a pregnancy?

The entire cost of health care for a full term normal childbirth performed in a hospital setting varies according to the economics of the area. An average cost will range between $10,000 and $12,000. The total cost will be allocated in three approximately equal parts for pre-natal care, delivery/birthing, the hospital delivery room and one over night stay. If you have a health care plan that has a Deductible and Coinsurance provisions you can expect to pay anywhere from 30-50% to cover the Out-of-Pocket provisions. You must factor the portion of the monthly Premium that is being assessed for the maternity coverage as well (since you must apply for maternity coverage before becoming pregnant you can expect to pay the allocated amount times 12 at a minimum). All this adds up to the fact that most of the cost of having a baby is borne by you. Unless, of course, you have planned ahead and have maternity coverage with a health care plan that has a low deductible and low Maximum Out-of-Pocket provisions or you happen to work for a large corporation that has an extraordinary rich benefit plan.

Some doctors are willing to negotiate the pre-natal and delivery charges assuming a normal pre-natal process and natural delivery, but many doctors shy away from getting involved in such situations because they must ethically stay with the pregnancy even if things get more complicated.

You should consult with a Licensed Certified Field Broker/Agent ( Click Here) who is well versed in maternity care benefits and any state or local resources to provide maternity related health care for those without coverage.

Will health care plans typically pay for infertility procedures?

The short answer is not likely. Infertility and related vasectomy or tubal ligation reversal procedures are considered non-medically necessary procedures and normally not found in a health care plan.

Non-InsurancexOptions

If one does not have maternity coverage and is not eligible for any of the state or federally subsidized plans then a discount care plan may be worth looking into MaternityCard and Maternity Advantage Program are two such programs. They are mentioned here only to offer a specific option for you to check into as a means of last resort once you are convinced no other options are available to you. Consult with the staff at your Ob/Gyn’s office as they are typically well versed on alternative options that may be available to you.

The cost of a maternity benefit is expensive, but even if you end up paying a bit more money each month to have maternity coverage, it will be worth it in the long run. What you pay out monthly will be not likely be as expensive as paying for the pregnancy with no coverage. It is important that you think ahead and make sure that you have maternity health care coverage on your plan in advance of actually needing it.