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Maternity Insurance 2014 Question & Answers

2013 August 30
by Sarah Fields

Mary asks…

Under the new federal health care act is a single man required to purchase maternity leave coverage?

As of March 29, 2010, is a single man required to purchase maternity leave coverage as a clause or part of his private health insurance plan?

Sarah Fields answers:

The new federal health care act does not take effect until 2014, with a few exceptions, so no.

However, maternity leave is not covered by a health plan, it would be covered by FMLA.

Lisa asks…

Do women have to pay for child birth in America?

I heard that hospital costs for child birth can be as high as $10,000 in the USA. If its true how do people cope when they can’t pay? Surely everyone giving birth in the States can’t afford this amount. Does insurance cover all of this? What if a woman isn’t insured or can’t afford insurance. Does this mean hospitals will turn people away?

Sarah Fields answers:

If you are insured through your employer, most if not all of your childbirth expenses (including prenatal care) will be covered.

If you are poor (<$20,000 a year or so), you can qualify for state assistance, which will cover most if not all expenses.

If you are not poor but are uninsured, or if you are self-employed, you must pay for it yourself. Completely.

The really striking thing is that self-employed individuals cannot even get maternity insurance in most states. The ones that do offer it do so with a full one-year waiting period. That means that you have to pay for the insurance for a full year prior to pregnancy in order for it to cover any of your birth expenses. And even then it may not cover the full amount, because there's nothing that says it has to.

That is supposed to change in 2014. We'll see.

Here's a good article on that issue: http://www.politicsdaily.com/2010/04/23/paying-the-price-for-maternity-till-health-reform-kicks-in/

Hospitals generally don't turn people away, and many people work out plans with their hospital in order to get the cost a bit lower.

Sharon asks…

I Just found out that I am expecting.. I have insurance but it does not cover Pregnancy?

I’m about 6 weeks pregnant, I have insurance through my father but it does not cover pregnancy. I have already applied for pregnancy medicaid but the most you can make is 1437 a month. With the over time that i work i probably make around 2800 a month. I am kind of stuck, I can’t afford insurance now that i am pregnant 500 a month plus fees to see the doctor will be more than i can handle.. I just don’t know where to turn, i have had a miscarriage before and i dont want a repeat i want to see a doctor ASAP so if anyone could give me any ideas on what to do with this situation i would really be greatfull.. Thank You!

Sarah Fields answers:

Unfortunately, health insurance companies are not going to extend maternity coverage to you now that you’re pregnant. Pregnancy is considered a pre-existing medical condition and grounds for declining your application. This will change in January 2014 due to the health reform law but that isn’t going to help you now, I’m afraid.

There are a few possible work-arounds, but they may not work for you personally.

First, if the baby’s father is employed with health insurance coverage, and if you two were to get married, you could then enroll in his employer-based health insurance plan, which is bound to provide maternity coverage.

You could also try to get a new job that offers employer-based health insurance, since they cannot turn you down for pre-existing conditions – though they may delay your coverage for pregnancy a bit. Make sure you understand how coverage for maternity care would work with any benefits package offered by a new employer.

If neither of these is an option, and you don’t qualify for Medicaid, you should find out if there are any other state-sponsored coverage options available for you. Contact the non-profit Foundation for Health Coverage Education at coverageforall.org. They can provide you with a list (and contact information) for the different government coverage options in your state.

If all else fails, you’re going to need to look into doctors or clinics in your area that may provide you with a discount on your maternity care, or where you can pay on a sliding scale based on your income.

You’re also going to need to think about health insurance coverage for the baby. We covered this in some depth on our blog, if you want to explore those options in more detail:

http://blog.ehealthinsurance.com/2012/03/where-can-i-get-health-insurance-for-my-baby/

Best wishes.

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