How the new healthcare law changes maternity care


My husband and I got married in December of 2005 and spent the first few years of our marriage enjoying each other without the responsibility of children. Then, after a few years, I found myself longing for a child of our own. Unfortunately, a giant roadblock stood in our way — our health insurance plan did not cover maternity.

Those were the days before the new healthcare law commonly known as the Patient Protection and Affordable Care Act (PPACA) and Obamacare came into play. At the time, health insurance providers were not obligated to offer plans that covered maternity and those that did often charged ridiculous sums of money for a “maternity rider” that covered pregnancy and delivery. Unfortunately, I would soon find out just how hard it was to qualify for this kind of coverage in the pre-PPACA era.

Maternity coverage in the pre-PPACA era

From the beginning to the end, trying to secure the proper coverage to have a baby was a nightmare. I quickly learned that few insurance providers in Indiana offered policies on the open market that included maternity care, and the ones who did weren't exactly embracing new maternity customers with open arms. In fact, I applied to Anthem twice and was denied both times due to a back surgery I'd had in my early 20s. Because of my pre-existing condition, my insurance agent suggested that I wait five more months (until it had been five years since my surgery) to apply so that I wouldn't have to mention the surgery on my application.

I followed his advice and finally was accepted to a plan with maternity about six months later. However, the waiting game was far from over. Maternity coverage for my new plan had a waiting period of 12 months, meaning that I wouldn't be covered if I got pregnant right away.

So I waited … and waited … and waited some more until I had reason to believe my pregnancy would be covered- even if I went into labor early. Fortunately, I was lucky. I got pregnant in 2008 and had my first daughter in April of 2009.

Looking at her for the first time told me that she was worth the wait — and that all the hassle and stress we experienced was worth it. On the other hand, I thought to myself, “Does it really have to be this hard?” Fortunately, the answer to that question is changing.

How the PPACA changes maternity coverage

The new healthcare law has inarguably created a new wave of winners and losers than those that existed before. People who make too much to qualify for the subsidies that make health insurance affordable are struggling to afford the new plans in some cases. Meanwhile, millions of others are now gaining affordable health insurance for the first time in their lives. Individual experiences with the law may vary, but it seems to me that women (and men) who want to have children may be on the winning side of the equation by and large — at least they are for now.

Since maternity coverage is now one of the mandated essential benefits required by the new healthcare law, women who buy their insurance on the open market will never again have to experience what I went through. And since pre-existing conditions are no longer a consideration under the law, there are no waiting periods for coverage either. In other words, if I were in the same predicament as I was several years ago, I could simply apply for a plan that meets my needs and try for a child right away.

Choosing a new plan during open enrollment

With that being said, if you are planning a family, there are some things to look for and watch out for when selecting a new health insurance plan. Here are a few tips that can help:

  • Make sure your doctor takes your new coverage –– In order to keep costs as low as possible, many of the new plans offered have very narrow networks that include few doctors and healthcare providers. When shopping for a new plan, it is important to make sure that your doctor accepts the coverage you are considering. All plans offered on healthcare.gov include information on provider networks and a search tool that makes it easy to browse providers.
  • Check hospitals too — Unfortunately, narrow network plans often keep the number of hospitals you are able to access at a minimum as well. When selecting your new health insurance plan during open enrollment, make sure the hospital of your choice accepts the coverage you choose. Otherwise, you could end up giving birth elsewhere or paying more than you want for out-of-network care.
  • Think long and hard about your deductible — Still, choosing a new health insurance plan is about much more than hospitals and doctors. You also want to keep your pocketbook in mind. When shopping for a new plan, remember that your out-of-pocket maximum will likely be reached the year you have a baby. And with bronze plans carrying deductibles as high as $13,000 for 2015, you might be better off to select a more expensive plan with a lower out-of-pocket maximum — at least for this year.
  • Remember that open enrollment is for a limited time only — Before Obamacare was passed, you could buy and change plans at any time throughout the year. However, the new healthcare law changed that by creating open enrollment periods that only last a certain number of months each year. According to Ryan Chow from Insure.com, open enrollment for 2015 runs from November 15 of this year until February 15, 2015. Outside of those dates, you can only sign up for a new health insurance plan if you have a “qualifying life event.” According to healthcare.gov, examples of qualifying life events include moving to a new state, experiencing certain income changes, and changes in family size such as having a baby or divorce.
  • Don't forget to check if you qualify for a subsidy — The new health care law includes subsidies that make health insurance more affordable for people whose annual household income comes in under certain thresholds. For example, subsidies are available for people earning up to 400 percent of the Federal Poverty Limit (FPL) for 2015, which means that a family of four making up to $95,400 next year could qualify. Also keep in mind that subsidies are based on MAGI (modified adjusted gross income). In other words, certain financial moves such as contributing to a qualifying retirement account or health savings account could help you qualify for a subsidy.
  • Consider a health savings account — Health insurance plans that meet certain guidelines also allow consumers to use a health savings account to save for qualifying healthcare expenses with pre-tax money. According to IRS.gov, individuals can contribute up to $3,350 and families can contribute up to $6,650 in 2015. To qualify, you must choose a health insurance plan with a minimum family deductible of $2,600 or individual deductible of $1,300 for 2015.

The new healthcare law is far from perfect, but those who were unable to secure health insurance with maternity before may now have the opportunity for the first time ever. Unfortunately, narrow networks and high deductibles may limit your options somewhat as you seek out new plans.

When shopping for a new plan during open enrollment, make sure to evaluate every aspect of any plan you consider in order to find the best deal possible for your unique situation. The new healthcare law has likely changed maternity care for the better, but only if you take the time to understand your options and the costs involved.

Do you think the new healthcare law has changed maternity coverage options for the better? How will the deductible affect your decision about which plan to choose?

More about...Health & Fitness, Insurance, Planning

Become A Money Boss And Join 15,000 Others

Subscribe to the GRS Insider (FREE) and we’ll give you a copy of the Money Boss Manifesto (also FREE)

Yes! Sign up and get your free gift
Become A Money Boss And Join 15,000 Others
guest
27 Comments
Oldest
Newest Most Voted
Inline Feedbacks
View all comments
Mr. Frugalwoods
Mr. Frugalwoods
5 years ago

Definitely a good idea to plan pregnancy around health insurance coverage. Too many people don’t think one bit about it, and are shocked when they get the bill.

While everyone’s situation will vary, I’d highly recommend getting a more expensive plan that has lower out of pocket maximums for the years where you are having kids. Then drop back down to a cheaper plan when the risky health period passes.

Is it gaming the system? Yes. But if they didn’t want you to do that there would be a rule against it.

JoeM
JoeM
5 years ago

I don’t think it’s really gaming the system when on the Marketplace they lay the numbers right out in front of you for what each plan costs and covers. Most plans even have the brochure/plan detail that breaks down costs for something like delivery of a baby and what the provider and patient pay.

It’s just being smart and taking the 20 minutes (or less) to review your options and making the best choice for you.

J
J
5 years ago

I wouldn’t even consider that to be “gaming the system”. In fact, I would consider it an unwise waste of money to NOT do that. The rules of the system exist to extract money from us in exchange for potential services, and properly managing your cost-to-expected-service ratio is just as important as managing your day-to-day personal budget. Anybody trying to claim it’s somehow immoral to do something like that would be kinda like a creditor claiming that it’s immoral for you to craft a budget and plan your payments because it’s gaming the system to allow you to get out… Read more »

Holly
Holly
5 years ago
Reply to  J

I agree with you- I don’t think it’s gaming the system at all. Everyone should reevaluate their plan during each open enrollment and adjust as needed. Once you’re done having kids, it might not make sense to pay a higher premium and have lower out-of-pocket costs. Of course, it all depends on the individual situation.

Robert Jacobs
Robert Jacobs
5 years ago

Very good article. Factual and to the point. Consumers have a lot to think about when choosing plans and deductibles. The jury is still out on the ACA. Some winners, many losers, lots of red tape.

Alex Welk
Alex Welk
5 years ago

I would hazard to say that the reason most companies didn’t offer maternity coverage and why it is expensive is that the insurance model is not a good way to cover it. If someone is purchasing maternity coverage, they will use it. At best, this means that the company charges you the amount you would pay for the coverage, plus overhead, over the duration of time you have the insurance coverage. Having said that, we all have to work with what we’ve got. Philosophically and rationally, saving or getting a loan for your own maternity costs would be the most… Read more »

stellamarina
stellamarina
5 years ago
Reply to  Alex Welk

Saving up to have a baby may work for a normal birth….could even have the baby at home to save money…but you really need insurance to back up if things go wrong. Cesarean section costs, then what happens if you have a premature baby with severe problems that means an intensive care nursery for a few months.

Brenna
Brenna
5 years ago
Reply to  Alex Welk

You bring up a great issue – saving up for medical expenses. I think this would be realistic if the costs were not so over-inflated and distorted. A)the hospital and doctor fees for the whole process, pre-natal through delivery and hospital stay are in the thousands (Add in prenatal, delivery-related and post-partum healthcare, and you’re looking at an $8,802 tab, according to a Thomson Healthcare study for March of Dimes.from parents.com) closer to $15,000 with a c-section. That’s a lot to save up just to start a family.If you didn’t use a hospital, but had the full-care of a midwife… Read more »

Courtney
Courtney
5 years ago

The new health care law also requires most health insurance plans to provide breastfeeding equipment and counseling for pregnant and nursing women. I received a double electric breast pump with my pregnancy and a supply of milk storage bags for 1 year after the birth of my daughter. This greatly helped with the return to work and being able to pump. Now if this country could just work on some legitimate maternity leave for mothers…

Bret
Bret
5 years ago

Nice article. Informative and right to the point. Also showed both sides. I wish I could get my news the same way.

Emily @ Simple Cheap Mom
Emily @ Simple Cheap Mom
5 years ago

I’m sorry you had to wait to meet your daughter for long because of paperwork. But you would have an entirely different baby any other month, so sometimes things to happen for a reason. As a Canadian, this whole process of thinking seems to foreign.

Beth
Beth
5 years ago

I thought this was a really interesting post, though the U.S. health care system puzzles me! Is it not in society’s best interests to have healthy moms and healthy babies?

Linda Vergon
5 years ago

(This comment came from Rebecca, a reader of our daily newsletter.)

AWESOME, thank you! Hopefully you get a good comment thread on this post.

Rebecca

Sharon
Sharon
5 years ago

Sure, it’s wonderful that you now have maternity coverage where you had none before. But where is the logic in making people beyond child-bearing age pay a higher premium for a policy that covers unneeded maternity coverage just because the ACA says it’s a minimum requirement? We should be able to pick a policy that applies to our personal situation, not a one size fits all policy.

nicoleandmaggie
nicoleandmaggie
5 years ago
Reply to  Sharon

Insurance doesn’t actually work if people are only insured for things that they actually have and know they have. That’s kind of the point of insurance.

LeRainDrop
LeRainDrop
5 years ago

Right, insurance is a risk-mitigating tool. But in the situation Sharon describes — the woman beyond child-bearing age — there is absolutely no risk/possibility that that medical event would take place. So why pay for that coverage?

Leigh
Leigh
5 years ago
Reply to  LeRainDrop

Why should my property taxes pay for the education of the children around me when I don’t have children? Or why should my Social Security and Medicare taxes help pay for the retirement of my grandparents and parents? I’m all for a society in which children are educated and my and my friends’ grandparents aren’t homeless.

Julie
Julie
5 years ago
Reply to  LeRainDrop

Then lets call it what it is, which is a tax/redistribution of wealth rather than health insurance.

Alex Welk
Alex Welk
5 years ago
Reply to  LeRainDrop

I appreciate that you care about the elderly and children but I do not appreciate the false dichotomy in which forced taxes (through inefficient and notoriously skeezy politicians) are the only possible way to accomplish those things. I would just be careful with the argument that someone’s preferences or needs justify taxation, to be sure that those things are applied universally and that they are for sure only possible through taxation. Your friendly neighborhood anarchist here to say that we are looking for solutions to the same problems of caring for the elderly, educating the children, etc. We’re just on… Read more »

Beth
Beth
5 years ago
Reply to  LeRainDrop

@Alex and Julie — I think one misconception Americans have about universal health care is that everything is “free”. We rely on employer-provided benefits or supplementary insurance for a lot of things, and many of us pay out of pocket for things that neither provincial health care nor our supplementary insurance (if we have it) cover. I don’t think Canadians see universal health care as “wealth re-distribution” — we see it more as a basic human right. From an outsider perspective, it seems like the American attitude towards health care is focussed on individuals rather than the community — along… Read more »

Holly
Holly
5 years ago
Reply to  LeRainDrop

@Beth-

One of the problems with the new healthcare law is that it has created huge financial burdens on certain segments of the population in its effort to assist others. The ACA is nothing like universal healthcare, unfortunately.

Like I mentioned in this post, I do think it benefits people who want to have children since they will no longer have to just through the hoops I did. But the law is harming other groups in the meantime. I think that is where part of the anger comes from.

JoeM
JoeM
5 years ago
Reply to  Sharon

Sharon,

Using that same logic, why should I as a healthy 26 year old non-smoker male with no allergies/prescriptions or conditions, have to pay more to support all the extra care and procedures that someone of your older age is more likely to require? It’s a slippery slope if you try and use that logic.

Just like with taxes, you can’t choose to fund local schools and not local police. You can vote to choose who creates those laws, but that’s that.

Jen From Boston
Jen From Boston
5 years ago
Reply to  Sharon

Where is the logic, then, of me, a woman, paying insurance premiums to subsidize a man’s vasectomy or prostate cancer treatment? Or of me, who is childless and unlikely to have children, paying insurance premiums to subsidize vaccinations and well-child visits for someone else’s children? Sure, you can argue that a woman can plan to have a child, but let’s face – not all pregnancies are planned. What if Holly’s birth control failed before she could get maternity coverage? Either she has to go through the emotional and ethical trauma of an abortion, or she goes into debt paying the… Read more »

Sarah
Sarah
5 years ago

Don’t forget too if you are already on a plan and don’t get a new one through the exchange your plan could be ‘grandfathered’ in that it doesn’t have to cover maternity care. I’m in that situation now living in a low-cost area making decent money and I would be in financial dire straits if I didn’t have the option to get on an exchange plan.

Rob Sorbo
Rob Sorbo
5 years ago

My wife had to suddenly change insurance on October 1 and our baby was born on October 14. We found a policy with a low deductible, and almost all of our expenses have been covered (ended up having pre-eclampsia, C-section, and 5 day hospital stay, so it would’ve been pricy). We’re very thankful for the new provisions of ACA.

Jim Mondry
Jim Mondry
5 years ago

This was a great article, and well written. I’m really greatful that I live in Canada, and that I did not have to worry about some of these stresses (I was interested becuase my sister does live in the states, so I was curious about the reality of insurance and how it impacts families). For what it’s worth, NPR’s show, Planet Money did a great article on insurance – http://www.npr.org/blogs/money/2014/09/19/349650496/episode-570-the-fine-print One of the things that is typically “uninsurable” are the issues like “earthquake insurance”, where the only people who are willing to pay for it, are those that are going… Read more »

Tre
Tre
5 years ago

I think the new laws are moving healthcare in the right direction for coverage, but the costs need to be addressed. 20%+ increases every year are not sustainable.

shares