After you are pregnant, it is not possible to get an individual insurance policy. If you are in the process of planning your pregnancy, the best options for minimizing your maternity costs are Medicaid, group insurance, and prepayment plans.
In 2007, the average total maternity charges submitted to Blue Cross Blue Shield of North Carolina was $20,015 per pregnancy.1 This is the full amount that a patient may be required to pay; however, many families negotiate with hospitals and providers to pay a discounted rate when the only option is to pay out of pocket.
When planning to cover the costs of maternity, there are primary options in North Carolina:
1. Group maternity insurance coverage. Maternity coverage through a group policy is often the best option because it’s more likely to be comprehensive and easy to get. Also, if you’re already pregnant and don’t meet the income requirements for Medicaid, getting group coverage is your best bet. And, in some cases, group policies don’t consider pregnancy a preexisting condition. So if you’re already pregnant, this could be a good way to get covered.
After you’ve submitted the charges to your insurance company, it’s always worth asking the hospital if you can get a discount by paying your deductible in full, rather than making payments over time. I know of instances where people have received a discount on their deductible for making a prompt, full payment.
2. Individual maternity insurance coverage with Blue Cross Blue Shield. Up to date, the only health insurance company in North Carolina that I know of that offers maternity coverage is Blue Cross Blue Shield. Their policies are Blue Advantage and Blue Options HSA SM. Also, to my knowledge, there are no health insurance policies that will cover you after you have already become pregnant. HumanaOne no longer offers an individual maternity policy. I would be wary of small health insurance companies that do offer this type of policy because they are usually on a tight budget. This can often result in their policies having unsavory loopholes.
The Blue Cross Blue Shield individual policy is a good option for people who want more predictability when it comes to their pregnancy costs. The premiums for the maternity rider are substantial, but in the event of complications, your costs will be covered. This is often a more desirable option than a straight prepayment plan because complications can often be quite expensive.
The deductibles and coinsurance of the plan you have selected will be used for your maternity coverage. To get the best value, it is important to compare the cost of the maternity riders within the context of each plan’s deductible and coinsurance. For example, if one plan has a maternity rider that costs $350 per month, and this plan has a $2,500 deductible with 100% coinsurance, then the total cost for pregnancy coverage over the course of a year would be $350 times 12 months = $4,200 + the $2,500 deductible = $6,700. If a second plan had a maternity rider that cost $450 per month, this would be more expensive than the first option. If this plan had a $1,500 deductible with 100% coinsurance, the pregnancy would cost $450 times 12 months, plus the $1,500 deductible, for a total of $6,900. In this hypothetical scenario, the first option is actually better even though the deductible is higher. This example illustrates the importance of paying attention to how much it costs to lower your deductible.
Blue Cross Blue Shield’s maternity plan has a few things to keep in mind timing-wise. The individual deductible resets every January 1st, so it would be best to start a policy at the beginning of the year and start trying to get pregnant then. Otherwise, the pregnancy could overlap calendar years, and you may have to meet your deductible more than once.
3. Medicaid maternity coverage. Visit the NC state Medicaid website for the most up-to-date income eligibility requirements.
4. Prepayment plans. If you are already pregnant, a prepayment plan should only be used as a last resort. In this case, you should contact the prenatal and delivery caregivers to negotiate a prepayment rate. Many hospitals offer discounts for paying out of pocket in advance. When conducting prepayment negotiations, it is important to be very specific about what exactly is covered by the arrangement and if the price includes complications of pregnancy, or only normal delivery.
Medicaid is almost always the cheapest option for prenatal care, with group insurance being the next best thing. If you have Blue Cross Blue Shield, that’s the third most affordable way to go. And then fourth on the list would be a prepayment plan that you set up directly with your provider.
The average amount that Blue Cross Blue Shield NC members were charged for maternity services in 2007 was $11,261. This amount will vary depending on the provider, the services rendered, and the location of the hospital.