Having a baby can break the bank if you lack insurance with comprehensive maternity coverage. But experts say the federal health care reform law will help more women get insurance that covers pregnancy and birth.
For decades, federal law has required group insurance plans offered by employers with more than 15 employees to cover pregnancy, childbirth and related conditions for employees and their spouses.
But women with small group or individual insurance often have trouble getting maternity coverage. In fact, only 12 percent of individual insurance policies cover maternity care, according to a 2012 report, “Turning to Fairness,” by the National Women’s Law Center. And a pregnancy without complications can cost about $10,000, according to the NWLC.
“Plans that don’t cover maternity care clearly are not covering what women need, and that’s unacceptable,” says Judy Waxman, vice-president for health and reproductive rights for the NWLC. The good news, she says: the federal Affordable Care Act, passed in 2010, will change maternity coverage starting in 2014.
5 ways Obamacare will improve maternity care
Here are five ways experts say the ACA will improve maternity coverage and care:
1. Women will be able to get insurance without paying more than men.
Pregnant and need individual health insurance now? Don’t count on getting it: pregnancy typically is considered a preexisting condition, experts say. Even women who aren’t pregnant routinely get turned down for coverage on the individual market – or, if they can get a plan, they often pay more than men. In 17 states, the practice of “gender rating”, where women are charged more for health insurance is banned or limited, according to the NWLC.
In states where insurers are allowed to charge women more, 92 percent of the best-selling individual plans do so – typically 30 to 50 percent more on average in many states, according to the 2012 NWLC report. Starting in January 2014, all applicants will be able to get health insurance, even if they have preexisting conditions – and women can’t be charged more.
2. Contraception with no cost sharing will aid pregnancy planning.
All new health plans that started on or after September 23, 2010 must cover preventive services with no cost sharing – and this includes all types of contraception approved by the U.S. Food and Drug Administration. Half of all U.S. pregnancies are unplanned, Waxman says.
This provision in the ACA will help women better plan pregnancies, make sure they’re in good health before they conceive and get early prenatal care, says Adam Sonfield, senior public policy associate with the Guttmacher Institute, a nonprofit that does research, policy analysis and education on sexual and reproductive health.
3. Women will get some prenatal care without having to pay anything out of pocket.
The ACA preventive care provision will allow women to get some prenatal care with no copay or coinsurance – the portion of care that the patient must pay – even if they haven’t yet met their deductible, Sonfield says. While states still are working out some specifics of how they will follow certain ACA requirements, experts say prenatal check-ups likely will be counted as well-woman visits, which are included on a list of free preventive services. This could save pregnant women hundreds of dollars, or more, because prenatal care can require 10 to 15 doctor visits, Sonfield says: “Those copayments can really add up.”
Other free preventive services for pregnant women include prenatal vitamins and regular screening for anemia and urinary tract infections.
4. Health insurance plans must cover maternity care.
Currently, maternity care is excluded from most individual plans. In some cases, a woman may buy a maternity rider – an addition to a policy – but that could cost almost as much as paying out of pocket for prenatal care, labor and delivery and postpartum care, Sonfield says.
Starting in 2014, all individual and small group health insurance plans sold inside and outside of the exchanges – the health insurance marketplaces created by the ACA – must cover 10 essential health benefits including maternity and newborn care. This means women who buy individual insurance can count on getting the medical care they need, Waxman says.
5. After childbirth, the mother and baby will get care. Postpartum care for the mother and newborn care for the baby are included in the ACA essential health benefits requirement. This care could include a hospital stay of a few days, regular checkups and counseling about newborn care and breastfeeding, Sonfield says. But in some cases – especially when a baby is born prematurely and requires a stay in a neonatal intensive care unit – it can get expensive, he says. “In really extraordinary cases, it can be upwards of a million dollars if something goes really wrong,” Sonfield says, adding that there’s no way for a pregnant woman to know whether there will be complications and what her costs will be. “That’s the whole point of insurance,” he says.
Will Obamacare cover all maternity care costs?
There still are some loopholes in pregnancy coverage. The ACA now requires health insurance plans to allow children to stay on their parents’ plans up to age 26 if they can’t get coverage through work, but maternity care can be excluded for dependents. However, the ACA prohibits sex discrimination, and the NWLC this month filed federal sex discrimination complaints against five large public and private employers over this issue.
There is a good chance that insurance companies will take action on their own to extend maternity coverage to dependents, Waxman says: “We’re extremely optimistic that this problem will be fixed.”