Evaluates the four primary maternity insurance coverage options in NC, including Medicaid, group health, individual health insurance, and prepayment plans. Learn how some women are able to secure coverage after they are already pregnant.
There's not much information available online regarding strategies for planning to pay for maternity, including delivery and prenatal care in North Carolina, so I've decided to write this article to provide a little insight on the issue.
If you are currently pregnant, your options, in order of desirability, are Medicaid, group insurance, and prepayment plans. After you become pregnant, it is not possible to issue an individual policy. Your application will automatically be declined. If you are in the process of planning your pregnancy, the best options for minimizing your maternity costs are Medicaid, group insurance, individual insurance with Blue Cross Blue Shield, prepayment plans, in order of descending desirability.
The average total maternity charges submitted to Blue Cross Blue Shield of North Carolina in 2007 was $20,015 per pregnancy 1. A patient may be required to pay this full amount, however many families negotiate with hospitals and providers to pay a discounted rate when the only option is to pay out of pocket.
When planning to cover the costs of maternity the four primary options in North Carolina are as follows:
1. Medicaid maternity coverage. Visit the state website for application instructions and income eligibility requirements.
2. Group maternity insurance coverage. This is often the most advantageous way to pay for maternity costs because many group policies cover maternity for all females on the policy without an additional rider. Also, if you are already pregnant and don't meet the income requirements for Medicaid, this is your best shot at getting your pregnancy covered by an insurance company. Additionally, some group policies do not consider pregnancy a preexisting condition, so this is a good option to consider if you are already pregnant.
After the charges have been submitted to the insurance company, it is worthwhile to ask the hospital if you can get a discount by paying the deductible in full as opposed to making payments over time. I am aware of instances where the deductible has been discounted for a prompt payment in full.
3. Individual maternity insurance coverage with Blue Cross Blue Shield. At the date of this writing, I am only aware of one individual health insurance company in North Carolina that offers coverage for maternity. The company is Blue Cross Blue Shield and the policies are Blue Advantage and Blue Options HSAsm. I am not aware of any individual health insurance policy that will cover you after you are already pregnant. HumanaOne previously offered an individual maternity policy, but has since discontinued it. I am generally skeptical of small health insurance companies, if you are even able to find one that offers maternity, because they are often on tight budgets and as a result their policies often contain ungainly loopholes.
The Blue Cross Blue Shield individual policy is somewhat similar to a prepayment plan through a hospital, as the premiums for adding the maternity rider are fairly substantial. However, the benefit of the policy is that, in the event of a pregnancy that involves complications, your costs are much more predictable. Pregnancies with complications are often significantly more expensive than normal deliveries, so this option is more desirable than a straight prepayment plan.
Blue Cross Blue Shield's maternity plan uses the deductible and coinsurance of the plan it is attached to, so it is important to evaluate the varying cost of maternity riders within the context of the deductible and coinsurance of each plan. For example, suppose the maternity rider for a plan was $350 per month. Suppose this plan has a $2,500 deductible with 100% coinsurance. Now the total cost for the pregnancy over the course of a year is $350 times 12 months = $4,200 + the $2,500 deductible = $6,700 for the pregnancy. Now, suppose a second plan had a maternity rider for $450 per month. Suppose this plan has a $1,500 deductible with 100% coinsurance. Now the pregnancy would cost $450 times 12 months = $5,400 + the $1,500 deductible = $6,900. With this hypothetical scenario, the first option is better even though the deductible is higher. The purpose of this example is to illustrate the importance of paying attention to how much it may cost to lower your deductible.
With Blue Cross Blue Shield's maternity plan, it is also important to plan the timing of the pregnancy. The individual deductible resets every January 1st, so it is best to start a maternity policy at the beginning of the year and start trying to get pregnant at that point. Otherwise, the pregnancy will overlap calendar years and you may have to meet your deductible more than once.
4. Prepayment plans. If you are already pregnant, a prepayment plan is a last resort. In this case, you should contact the prenatal and delivery caregivers to negotiate a prepay rate. Many hospitals offer discounts for paying out of pocket in advance. When conducting prepayment negotiations it is important to be very specific about what is covered by the arrangement and if the price includes complications of pregnancy, or only normal delivery.
Overall, from a financial perspective, Medicaid is typically the least expensive option, followed by group insurance. Individual maternity with Blue Cross Blue Shield is the third most desirable as a measure to minimize the cost of unexpected complications of pregnancy. The fourth option is the prepayment plan negotiated directly with the provider.
NC Maternity Pregnancy Insurance Coverage
1. Average charges submitted to BCBSNC for maternity services, professional and hospital etc. in 2007. Your charges may vary
David Goebelt has been a licensed health insurance agent with Blue Cross Blue Shield for the past four years, two of which were spent brokering health insurance between multiple companies. He has a bachelor of science in economics and employs cost benefit analysis to assist clients in choosing health insurance policies.