Maternity and Individual Health Plans

Question.  What are the best plan options for maternity coverage? 

Expense Estimate      Let’s get this out of the way..maternity expense coverage is a large bill.  Maternity complications, hospital facility fees, anesthesia, and liability coverage have escalated premium costs.  The average maternity bill is around the $12,000.00 range.  On PPO plans you can expect to play the plan’s maximum out of pocket which is typically in the $6,000-$7,000 range.  This is because the deliver is typically 48 hours of inpatient hospitalization.  Inpatient hospitalization can average around $4,000 per day.  Maternity expenses can be 10-12% of monthly premium expense. 

HMO or PPO?           On the HMO plan maternity is typically a co-pay of say $250-$500.  Make sure the HMO medical group is contracted with the hospital where you want to deliver, and that your obstetrician is contracted within your primary care medical group.  Add up the 12 months of premium cost + the co-pay for maternity and you have total baby cost.  This number usually approaches $8000 to $12,000.

For PPO watch very closely whether or not the plan contains maternity benefits.  If so, then take a look at the plan’s annual out of pocket maximum and the deductible.  For many plans at carriers like Blue Shield of California and Pacificare of California you add the deductible to the annual out of pocket maximum to get your total risk.  At Blue Cross and Health Net of California the deductible is typically included in the annual out of pocket maximum. 

Alternative Medical Coverage

Health Savings Accounts are a strong strategy often overlooked when considering maternity.  A California Health Savings account typically has an annual total risk in the same ballpark as a standard PPO health plan.  The bonus is then you can deduct on your taxes the medical expense portion which will save you on average in the 30% range.  Note:  be careful of a single member Health Savings Account plan.  When the baby is delivered the plan deductible and maximum double as it switches to a family plan.  This occurs on the date of birth and includes the cost of delivery inpatient.  You need to be able to add the baby to an alternate health plan of the father’s to truly receive lowest possible cost.