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Maternity Insurance 2014 Question & Answers

2013 December 27
by Sarah Fields

Sandra asks…

Does health care reform influence the insurance market?

And more specifically, how does it affect premiums and how health care is distributed, and the way people purchase it?

I’ve been reading into how the free rider aspect can negatively influence the cost of health insurance and what that cost means to taxpayers. But does the health reform bill change how people choose to purchase insurance, such as what type? Will people purchase more short-term insurance for instance, over long-term insurance simply to fulfill the mandates?

And how does this change competition between providers? Are providers harmed?

Websites with information would be helpful. Thank you.

Sarah Fields answers:

Absolutely it does. Just look at the current result of the health reform act – you can no longer buy a child only health insurance policy, and maternity benefit options are rapidly drying up for individual policies. They’ll be gone before 2014, due to the “preexisting condition” exclusion not being allowed.

Prices are skyrocketing. Already, the cap has been lifted on lifetime coverage limits for children, and preexisting conditions can no longer be excluded for them. Estimates for coverage price increases come January 1st, are 25% to 40% across the board. This is to cover the extra costs, associated with elimintating caps on very sick children, and mandating coverage for preexisting conditions for them.

The result will naturally be, fewer people will be able to afford to buy health insurance coverage. Yep, we’ll have FEWER insured people. Also, the people good at math, will realize it’s cheaper to pay $700 fine, once a year, and only buy coverage when they have to file a big claim, than it will be to pay $500 every month, and ALWAYS have insurance in place. That “adverse selection” issue will have to result in the insurance companies coming up with a method to incentivize healthy people to buy health insurance, to offset the unhealthy people.

I think people aren’t going to bother to comply wtih the mandates. It’s cheaper not to. Just like welfare payments pay more, to women with children who are not married, giving them incentives to have children outside of marriage – this system encourages people financially to NOT buy insurance.

Sandy asks…

Why do women have to pay more for their health care than men?

I was reading an executive summary of the White house forum on women and Girls that just recently happened and I came across this sentence that said women have to pay for their healthcare than men. I never heard of this since I’m barely getting into women’s issues but, can anyone shed some light on this?

Sarah Fields answers:

The idea is that it’s because women cost more, but yet they did it for identical coverage which didn’t cover maternity.

However:

The new health care law will prohibit such “gender rating,” starting in 2014. But gaps persist in most states, with no evidence that insurers have taken steps to reduce them.

For a popular Blue Cross Blue Shield plan in Chicago, a 30-year-old woman pays $375 a month, which is 31 percent more than what a man of the same age pays for the same coverage, according to eHealthInsurance.com, a leading online source of health insurance.

In a report to be issued this week, the National Women’s Law Center, a research and advocacy group, says that in states that have not banned gender rating, more than 90 percent of the best-selling health plans charge women more than men.

Mary Beth Senkewicz, deputy insurance commissioner in Florida from 2007 to 2011, said the findings were consistent with her observations.

Insurers said they charged women more than men because claims showed that women ages 19 to 55 tended to use more health care services. They are more likely to visit doctors, to get regular checkups, to take prescription drugs and to have certain chronic illnesses.

But Marcia D. Greenberger, a president of the National Women’s Law Center, said the justification was “highly questionable” because the disparities varied greatly from one insurer to another.

“In Arkansas, for example,” Ms. Greenberger said, “one health plan charges 25-year-old women 81 percent more than men, while a similar plan in the same state charges women only 10 percent more.”

Differences in rates for men and women are not explained by the cost of maternity care. In the individual insurance market, such care is usually not part of the standard package of benefits. Maternity coverage may be offered as an optional benefit, or rider, for a hefty additional premium.

Donna asks…

where on earth can I find affordable maternity insurance?!?

I didnt have it with my son and we are looking to get health insurance but all the plans that are decently priced (under $350/month) dont cover maternity. even if I could JUST find a maternity insurance that would be great! does anyone have or know of any insurance companies that offer maternity coverage? if so what are the names? heres a little info

we live in FL
we have one child
my husband and I are 20 and 21 years old

if you know of any insurance that will have affordable rates please let me know so I can get a quote!
it doesnt only have to cover maternity, were looking for health insurance anyways. but all the ones that we can afford dont cover maternity.

Sarah Fields answers:

I’d recommend that you work through a licensed agent if you haven’t already. A licensed agent representing multiple insurers in your area can give you a broader view of what’s available, and what you might need to pay for the sort of coverage you want. It doesn’t cost anything extra to work through an agent.

Now, just to address a couple of the items you raise:

There’s no such thing as maternity-only coverage. What you need is health insurance, and in FL some plans come with maternity care, others don’t – at least when you’re buying coverage on your own. Maternity care is usually covered with employer-sponsored plans, so keep that in mind if you or your husband are looking for work.

When it comes to buying coverage on your own, things will change in 2014 when the final provisions of the health reform law come into effect. At that time, pretty much all major medical health insurance plans are going to cover maternity care, and subsidies will be available to help people making less than 400% of the federal poverty level pay for that coverage.

One more thing: keep in mind that if you are buying coverage on your own and are pregnant now, you’ll likely be declined. Pregnancy is considered a pre-existing medical condition. You’ll have to wait until 2014 before this changes.

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