Having health insurance to help foot the bill for any pregnancy is important. But this is especially crucial if your pregnancy is at high risk. Unfortunately, pregnancy itself is not considered a qualifying life event that allows you to purchase an insurance plan at any time. Ironic, since giving birth (or adopting a child) is.
But health insurance coverage is essential for childbirth and for all care before childbirth. Thus, to take out insurance or change plans before or during pregnancy, you will need to take advantage of an open membership period.
“Being insured gives the patient the opportunity to achieve the highest level of care without the outrageous sticker shock,” says Peace Nwegbo-Banks, MD, a certified OB-GYN based in Houston, Texas. “Because the costs of health care in the United States are sky-high, it’s important for patients to protect themselves. Even an uncomplicated pregnancy and childbirth costs tens of thousands of dollars. Costs start to skyrocket if additional care is needed. ”
Here’s how to take advantage of employer-sponsored or market-sponsored open enrollment periods. Plus, what you need to know about choosing a health plan if you’re currently pregnant or planning to conceive.
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Open registration details
If you don’t currently have insurance or want to change your plan, you can take advantage of the Health Insurance Market’s Special Open Enrollment Period (SEP) until August 15 to get 2021 coverage. This SEP is unusual and is in response to the COVID-19 pandemic and the recovery. Under the American Rescue Plan Act, more people now have access to savings and subsidized costs when purchasing insurance in the market.
Open market registration for 2022 coverage will begin on November 1 of this year. If you have existing coverage for 2021 and have paid a significant portion of your deductible, you may want to put the plan change on hold.
Most employer-sponsored plans keep their enrollment periods open in November for coverage the following year. You will therefore not be able to register or change coverage with your employer until then. Keep in mind that you may be eligible for Medicaid through your state. The good news is that you can apply for Medicaid at any time.
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The high price of risk
Pregnancy and childbirth are the costliest healthcare needs in a hospital setting, according to a report from the Healthcare Research and Quality Agency. The average cost of a vaginal birth is over $ 15,000. And a cesarean section (section C) can cost $ 5,000 and more, according to the Center for American Progress. But a high-risk childbirth can cost an uninsured patient even more.
Pregnancies are high risk based on a number of considerations. These include if you are a teenager or over 35 and first time pregnant, have certain pre-existing conditions, have multiples, or develop pregnancy-related conditions, such as gestational diabetes.
“If you include additional tests, fetal ultrasounds, consultations with specialists and a possible stay in the NICU, the final price is unpredictable,” says Nwegbo-Banks. “If mom ends up needing special care with the baby, it further increases the costs.”
Choose a package
If you’re shopping for insurance during open enrollment, there are a few things to consider, says Erin Scott, LCP, maternal mental health specialist and owner and clinical director of the Healing Space Counseling and Wellness Center.
Scott recommends checking to see if your OB-GYN is listed as a networked provider with the new plan. You don’t want to be hit by off-grid charges. And you don’t want to have to change doctors if you are comfortable and satisfied with your current provider. Also consider whether you have to pay a deductible before insurance that covers 100% of the cost of a doctor’s appointment and hospital stay, she says.
Market plans should cover preventative services without charging out-of-pocket costs, regardless of your franchise status. Preventive services for pregnant women include screening for gestational diabetes, prevention and screening for preeclampsia, breastfeeding support and counseling, and more. Maternity and newborn care are considered essential health benefits. Market plans must cover them. But patients may be responsible for copayments, coinsurance, or deductibles. The Affordable Care Act requires new private insurance plans to cover most, but not all, recommended preventive services, with no out-of-pocket costs for pregnant women. Check any potential new plan carefully to find out what’s covered.
“Early prenatal care is of paramount importance for mother and child,” says Kecia Gaither, MD, MPH, FACOG, dual certified in OB-GYN and Maternal Fetal Medicine and Director of Perinatal Services at NYC Health + Hospitals / Lincoln.
“Co-morbidities, such as diabetes or hypertension,” she adds, “can affect pregnancy outcomes. The detection and potential treatment modalities of these problems can prevent poor clinical outcomes such as preterm labor. , low birth weight infants and birth defects, to name a few. ”
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The “fourth quarter”
Gaither says those planning to have a baby should think about insurance needs that might arise before pregnancy and those that might arise after.
“It helps to choose a plan that provides coverage for preconception counseling, genetic services, for the ‘fourth trimester’, and that offers help for mental disorders associated with the peripartum period,” says Gaither. A 2013 study published in the British Journal of Midwifery found that having a high-risk pregnancy is a risk factor for postpartum depression, for example.
Before signing up for a new plan, also make sure that the coverage is adequate to meet a newborn’s needs, especially if something unexpected happens. Under a 1996 law, your plan should cover the care of your newborn from birth, provided you enroll your baby within 30 days of their arrival in the world.