Understanding Your Health Insurance Coverage – and the Costs – Of Pregnancy

If you’re considering having children, getting health insurance coverage is crucial during open enrollment, no matter if you want kids today, sooner or later. Put this on the priority list before picking names, baby-proofing the kitchen or picking paint colors for the nursery.

Planning and understanding the costs of pregnancy can go a long way toward less stress, better health outcomes for you and your baby and the growing family as a whole.

Almost 4 million people give birth each year. Many studies show an average American birth can cost more than $23,000 – yet it can be managed.

Know What Your Coverage Includes

You can’t get coverage as a life event when you become pregnant. That’s why getting insurance is an important first step when you start thinking about having a baby. 

If you have coverage: that’s great. But a true understanding how your health insurance benefits work takes some effort. Log into your coverage portal, call your plan’s customer service team or go back through hard copies of the documents and read them carefully. The more you know, the better off you’ll be.

Answering questions sooner versus later will help, too.

Preventive care services are covered with Affordable Care Act (ACA)-approved plans, including those offered by Avera Health Plans. Understanding the difference between preventive and diagnostic care is another important situation for any growing family.

Labs, clinic visits and imaging are parts of your 100%-covered preventive care coverage. Yet there are some exceptions.

If your ultrasound or lab indicates an issue with your baby’s health, costs may be subject to a co-insurance or a deductible.

You have coverage,  but it's important to understand what your plan includes and does not include at the beginning of your pregnancy. Further testing or the inclusion of a specialist in your care can mean some out-of-pocket costs. 

Not every coverage plan is the same. There are programs known as transitional plans; they are not ACA-modeled and may offer no coverage or omit prenatal care.

Understand Your Out-of-Pocket Costs During Pregnancy

Let's say you have a health insurance plan, and it's the "bronze" version of the coverage with an $8,000 individual deductible. You can dive into the details of your plan and how your costs – and those that are covered – online or with the help of a service professional from your provider.

If you have a $6,000 out-of-pocket maximum for the year, you will likely pay that out of your own personal finances until your expenses are covered at 100%.

If you have a high-deductible plan, you are responsible for that first dollar up to the total of the deductible. 

Add Baby to Your Insurance Plan After Birth

All newborn babies who have parents with ACA-approved health insurance coverage plans are covered, in most cases, shortly after the baby is born.

In case complications arise, or your baby needs a stay in the neonatal intensive care, you’re likely to incur some costs with your deductible and coinsurance.

Greater costs can kick in if mom or baby needs to spend more time in the hospital. Having a baby is a qualifying life event. Yet you must contact your health insurance provider – and do so in a timely fashion – in order to add baby to your plan. Reviewing resources can help, too.

Moving to a family plan makes sense to many new moms and dads. These plans have family and individual deductibles so it’s important to understand how they work.

How a Family Provider Can Save Money as Your Family Grows

It’s important to have a primary obstetrics (OB) provider, whether that’s an OB-GYN specialist, family medicine provider or certified nurse midwife.