What Pregnancy Really Costs
Wondering what your pregnancy will cost you? You may be surprised to learn there’s a huge range in prices depending on whether you have insurance or not. Labor and delivery are among the most expensive health care costs in the U.S. and without adequate coverage they can cost tens of thousands of dollars.
The good news: Health insurance can greatly reduce those costs. Read on for insurance basics along with tips to reduce your maternity costs.
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Health Insurance 101
Shopping for health insurance can seem as complex as doing your taxes — and it becomes even more complicated if you’re pregnant. So it first helps to understand the various health insurance terms you’re likely to hear:
- Premiums: The amount of money you’ll pay your insurance company monthly for coverage.
- Out-of-pocket cost-sharing: What you pay personally to your practitioner for medical visits and procedures, including:
- Co-pay: The amount of money you pay for each in-network doctor’s visit (the insurance pays the rest of the bill), which usually ranges from $25 to $50 (though if you have a high deductible plan, there are no co-pays, just a deductible and co-insurance).
- In-network co-insurance: The percentage you’ll pay if you have a bigger procedure (like C-section or delivery) at an in-network doctor or hospital (for example, your insurance may pay the first 70 percent, and you’ll pay the next 30 percent up to your out-of-pocket max).
- Deductible: The amount you pay before your health plan starts paying some share of the expenses. If your deductible is $3,000, you’ll pay for co-insurance out-of-pocket until you hit $3,000; at that point your health insurance starts paying for some of the expenses up to your out-of-pocket max, when they’ll start paying for everything.
- Out-of-pocket max: The most you’ll pay for health care in a year. This amount does not count your monthly premiums but does include copays and coinsurance you continue to pay after you hit the deductible.
Since pregnancy is a high-cost health expense even for women with health insurance, you’ll want to focus especially on the cost of premiums and the co-insurance to keep your overall costs as low as possible.
The Cost of Pregnancy With Health Insurance
You have several options for coverage, including Medicaid if you qualify; state or federal Marketplace insurance through the ACA; and private insurance through your employer or your spouse’s. Here’s how costs break down:
If you’re pregnant and your family falls below a certain income threshold — in 2013 in Maryland, for example, it was about $40,000 for a family of two — you can enroll year-round for Medicaid coverage with very little to no cost-sharing for maternity expenses. A 2010 report by research firm Truven Analytics, The Cost of Having a Baby in the United States. estimated the average Medicaid out-of-pocket expenses for a pregnancy at less than 1 percent of the total costs. Find out if you qualify for Medicaid using the Kaiser Family Foundation’s Medicaid and subsidy calculator. at Healthcare.gov or by calling 1-800-318-2596.
Open enrollment for marketplace coverage usually starts around November and closes the end of January. (Say, for example, you want coverage in 2016: You could sign up starting November 1, 2015 until January 31, 2016). So if you're expecting or thinking about pregnant and don't have healthcare coverage, it's a good idea to enroll during this period. There are five categories of Marketplace plans: Catastrophic, Bronze, Silver, Gold and Platinum. From Catastrophic up to Platinum, the premiums go up, while out-of-pocket cost-sharing goes down (but never completely away). If you expect to have a baby in the year and don’t qualify for Medicaid or have employer-subsidized insurance, the Silver plan is your best option, say health advocates who have reviewed the plans.
Though it’s too early to have an accurate national average for premiums and other expenses, here’s a representative example of what a pregnant woman with diabetes who delivers vaginally in Montgomery County, MD would be likely to pay on a Silver plan, using the zip code 20902 in the Healthcare.gov insurance calculator:
- Premiums: $418 for a couple per month, or just over $5,000 for the year
- Deductible: $4,000 annually
- Co-insurance: 70 percent covered by insurance; you’ll pay 30 percent out-of-pocket for some procedures, including delivery
- Out-of-pocket expenses: The costs in this scenario are just under $2,700 (and the average out-of-pocket maximum under the Silver plan is just over $6,000 for an individual and $12,700 for a couple or family)
So counting the deductible and out-of-pocket costs for labor and delivery, a Silver-tier plan would cost $6,700 total for a vaginal delivery (add about $1,500 more for a C-section). That's not including premiums, which adds another $5,000 for you and your spouse for the year. While this is just an example, a look through other zip codes found plans costing in the same range — some with premiums or deductibles that are higher or lower.
If your employer or your spouse’s does not offer health coverage, you may be eligible for subsidies to help pay for the cost of Marketplace insurance premiums if your income is 400 percent of the federal poverty level. That works out to $62,920 for a family of two and $79,150 for a family of three, and it applies only to most Marketplace Silver plans,
which still require you to pay 30 percent in co-insurance.
If you have private health insurance, a 2014 Kaiser Family Foundation survey found that average premiums for employees of large firms are similar to the Marketplace ones for the Silver plan, though the co-insurance tends to be lower (80 percent is covered by insurance) and the out-of-pocket maximums are sometimes lower.
Pregnancy Costs for the Uninsured
While maternity expenses for insured moms might seem high, the numbers are far higher if you have no insurance at all. The Truven Report put the uninsured cost of having a baby at anywhere from $30,000 for an uncomplicated vaginal birth to $50,000 for a C-section. And those prices have increased dramatically in the last four years. According to the National Partnership for Women & Families. the cost of having a baby increased 50 percent between 2004 and 2010, and they’ve likely increased since then.
Maternity costs can also vary from state to state by 50 percent and even more within some states, according to the Truven report. A 2014 study by the University of California, San Francisco found that hospital charges for an uncomplicated vaginal delivery ranged from $3,296 to $37,227, depending on the hospital. For a C-section, costs ranged from $8,312 to nearly $71,000.
If you’re concerned you won’t have enough money saved up to pay your bills by the time you deliver, your hospital may offer interest-free payment plan options, so contact their billing department to learn more.
How to Reduce Maternity Costs
How can parents-to-be protect themselves from super-high medical bills (and sneaky surprises)? Here are some other ways to save on pregnancy costs:
- Call your insurance company right away. Find out exactly what’s covered and what’s not. Ask if you have to use a specific provider or hospital, what procedures and tests are covered, and how many days you can stay in the hospital.
- Know your out-of-pocket costs. If you’re signing up for private insurance through an employer, compare plans to see whether it or a Marketplace plan would likely cost you less out-of-pocket for pregnancy. If you’re signing up for coverage through the Marketplace, compare costs online or call the insurer listed for more information.
- Opt for an HMO if one is available in your area. You can expect to pay the least out-of-pocket money if you choose an HMO, which limits you to specific doctors and hospitals — though you’ll typically have to pay a bit more in co-pay ($50 for an HMO vs. $30 for a PPO, for example) for each in-network doctor visit.
- Stay in-network. Avoid going outside of your network of doctors and hospitals, if possible, or you’ll pay more (as much as 50 percent of the cost).
- Open a flexible spending account (FSA). If your (or your spouse’s) employer offers one, these special accounts allow you to set aside up to $2,550 per person ($5,000 if your spouse has the same option at work) from your pre-tax annual salary, deducted in small portions from each paycheck. The tax savings are fairly small, but it does amount to a pretty painless savings plan — and you can access the full amount at any time.
- Question authority. Any time your doctor or midwife recommends an expensive test or procedure as part of your prenatal care, ask why it’s necessary and if there are other options.
- Go home early. If you feel good after 12 or 24 hours in the hospital and you get your practitioner's OK, don’t stay the full 48 hours your insurance allows. Most hospitals charge $800 to $1,000 a day for your stay — if you’re paying a percentage of that, leaving early is a money-wise move. Sure, you might sacrifice some Z’s by splitting the scene, but you’ll have more to spend on your sweet new baby (or to stash in a college savings account ).
- If you can, time it right. One thing to keep in mind if you aren't yet pregnant but are thinking about conceiving: If you get pregnant one year (say June) and give birth the next (in March), you'll likely have to pay the deductible twice, which could be a sizable cost. Getting pregnant and delivering your baby within the same year (if at all possible) could bring some savings.
- Take advantage of services after birth. Under the Affordable Care Act, a number of health services — including breast pumps and lactation counseling after the baby is born — are mandatory and come at no cost to you.
Renewing Marketplace Coverage for 2015
The Healthcare Marketplace open enrollment runs from Nov. 1, 2015 through Jan. 31, 2016. If you had Marketplace health insurance last year, you’ll be automatically re-enrolled in the same plan for 2016 — but it’s smart to actively re-enroll, since your doctor may no longer accept that coverage or another plan may be less expensive and still provide the coverage you need.
Start your search for health insurance plans at Healthcare.gov ; keep plugging in information and searching for options until you find the one most likely to fit your budget. Several organizations offer websites to help you learn more about Marketplace health insurance before the deadline, including:
Once your baby comes you’ll have up to 60 days to review your coverage and make changes that could save you money.
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