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 â€¦ and waited â€¦ 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?