In the United States individual health insurance coverage for maternity is best described as less than adequate for most families. In fact, if you are the average American in terms of assets and income you might be best suited applying for Medicaid. Medicaid is the best health insurance possible for pregnant women because it is free and offers coverage for the newborn as well for the first year provided there is no substantial change in income.
As a health insurance broker with a wife who is going to bear my fruit, you might be wondering what I am going to do for our family. The answer is nothing. I am going to either sign up with a maternity plan individually right before we decide to have children, or do a 2 man group through one of our subsidiary companies. Or, I might just pay cash and sign up for a maternity plan through our hospital. What I won’t be doing is flushing money away every month for a maternity plan that I might not need for several years.
Maternity Health Insurance Coverage
Maternity insurance is often an included insurance benefit offered by employers. There is usually a waiting period before the insured is allowed to get pregnant (3 months is the average) in order to eliminate the moral hazard of trying to obtain maternity coverage by getting a job when you are already pregnant. Of course some companies go a step further and make it an optional benefit with an additional expenses from the pay of the employee.
If you are reading this it is because you are already pregnant and have no health insurance coverage the good news is that your are with good company as 13% of all pregnant women are uninsured with an even higher amount being underinsured. You might even fall into the category of having health insurance with no maternity coverage which is just as common.
If this is your situation, the good news is that your health insurance plan does cover complications from the birthing process including c-sections and so on. If you have health insurance and it doesn’t cover normal maternity you should start calling local hospitals to find out the amounts they charge for an entire package of prepaid maternity. Oftentimes, the $4,000 they charge is less than you would have paid anyways after accounting for the $110 per month that most maternity optional benefits charge monthly. Most hospitals (especially community hospitals) offer payment plans and the $4,000 estimate is oftentimes higher than what you will pay in most smaller communities.
How Medicaid Works
Medicaid is federally funded state insurance program for certain (i.e. pregnant women) low income individuals and families. The first step is to determine if you qualify for Medicaid.
Unfortunately, the guidelines, income calculations, and restrictions differ between states. A simple rule of thumb is that if you make less than $30,000 a year, you should apply for Medicaid. So, Medicaid is a good option for average households, as it easy to qualify for as most Americans earn less than the $30k to get Medicaid.
Once you are enrolled in Medicaid, you will be provided with the appropriate documentation. The next step involves finding a healthcare provider that accepts Medicaid. Most states have a health department hotline which helps you find a local provider.
After receiving your Medicaid acceptance, you can make an appointment with your healthcare provider. Your healthcare provider will makes copies of your Medicaid documentation and provide you with the healthcare services (your prenatal care) that you need. In most cases, you do nothing else. Your healthcare provider will bill Medicaid directly and be reimbursed for the services that you received. There are some states that do have a small co-payment that you must make.
Go to your local DHS (Department of Health and Human Services) office. You should be able to find the local office online by searching for your state and DHS for instance the Minnesota DHS can be found here. You will need to offer proof of income and some forms of identification to qualify for assistance. You should bring: IDs (driver’s license), Social Security card, Birth Certificate, Last 30 days of check stubs, Copy of bank statements – including savings accounts. Bring everything you can along these lines including phone bills, power bills, and passport if these apply to you.
Don’t bother getting any silly discount cards or signing up for any programs that claim to be insurance, there are none for pregnant women. The only health insurance you might be able to get is group coverage depending on your state’s insurance laws and the fact that you have to own a business and offer the coverage to all of your employees. The discounts that these supposed health plans offer can be negotiated for free by you anyways and are tantamount to burning money.
If you have health insurance already with maternity coverage either through your employer or individually call the customer service line and inform that you are pregnant so that you don’t have to fight to get your claims paid later on. This means, don’t go to any OB-GYN that is not in your network, and make sure ahead of time that your health insurance company is willing to cover your prenatal visits and so forth. If you are going to need to fight with your insurance company to get your maternity covered, you might as well know before you start going to the best doctors in the country, because there is a good chance that you might need to pay these bills yourself, which will surely influence your choice of treatments, procedures, and choice of doctors.
United Health One Maternity
United Health One offers a decent maternity coverage in most states, and I call it decent because it is doesn’t have a very long waiting period. Most individual health insurance products have waiting periods and offer increasing benefits for the birthing process the longer the maternity coverage is in force. United Health One is a good example of this type of Maternity health insurance.
Blue Cross Blue Shield Individual Maternity
Blue Cross Blue Shield is owned by different companies in each state, so the maternity coverage options that they offer will vary greatly even within the same state, depending on your zip code. Still, Blue Cross is thought to be one of the more trustworthy brands in health insurance, and I recommend reviewing their maternity health insurance options if you are planning to get pregnant in the next few months by getting a Blue Cross Blue Shield health insurance quote.
When you use our online health insurance quote engine you will see all the maternity options in your particular state so this is the best way of reviewing your options if you are planning a pregnancy in the next couple of months. Otherwise, I would recommend taking the money you save on maternity health insurance and using to prepay for coverage with your hospital of choice if you are going to be having a baby in a few months or more.
Humana One & Cigna Maternity Coverage
In the majority of states, Humana One and Cigna individual health insurance plans do not offer maternity coverage, if not all. I haven’t run into any maternity coverage from either one. Although Humana One used to offer maternity coverage, and if you currently still have a Humana One individual policy with maternity it is still honored. Though, I doubt there are many people that have Humana One maternity coverage because it was so expensive when they did offer it.
Health insurance exchange plans include maternity and newborn care as a mandatory benefit, and therefore everyone in the nation has access to maternity coverage. Find out more about Maternity After Obamacare and exchange coverage to get up to speed with the current laws.