Is private health insurance with maternity coverage in DC even worth it?
February 8, 2013 7:04 AM Subscribe
Healthy 26-year-old woman in DC with private health insurance, planning to start trying to get pregnant at the end of the year.
I have been looking into private health insurance options that cover maternity, as neither myself not mr. crunchy has insurance through work. A few questions:
1. Seeing as all of the plans I can find that cover maternity are super expensive, is it worth doing? Would I be better off keeping my current plan and just paying the negotiated but not covered rates? (I'm seeing rates starting at $450/month and going up rapidly from there. We currently pay $175/month for a high deductible, low out-of-pocket max plan that works very well for us.)
2. For those who have had a child in DC with private insurance, how did you do it? I'd also be interested to hear from people outside of DC with private insurance.
3. We're very interested in going the midwife route. Are there options for insurance or something similar for this? Are we better off just starting a savings account now?
I have been looking into private health insurance options that cover maternity, as neither myself not mr. crunchy has insurance through work. A few questions:
1. Seeing as all of the plans I can find that cover maternity are super expensive, is it worth doing? Would I be better off keeping my current plan and just paying the negotiated but not covered rates? (I'm seeing rates starting at $450/month and going up rapidly from there. We currently pay $175/month for a high deductible, low out-of-pocket max plan that works very well for us.)
2. For those who have had a child in DC with private insurance, how did you do it? I'd also be interested to hear from people outside of DC with private insurance.
3. We're very interested in going the midwife route. Are there options for insurance or something similar for this? Are we better off just starting a savings account now?
You really won't even need anything to go wrong for it to get really expensive quickly. If you need a C-section it'll get over $20K in hurry.
posted by COD at 7:15 AM on February 8, 2013 [1 favorite]
posted by COD at 7:15 AM on February 8, 2013 [1 favorite]
We had two kids in DC via cesarian with private insurance. The bills that we saw cost in the neighborhood of $80,000 per kid. You won't hear me admit it, but thank god for insurance.
posted by The 10th Regiment of Foot at 7:16 AM on February 8, 2013
posted by The 10th Regiment of Foot at 7:16 AM on February 8, 2013
Delivering a child in a US hospital will cost upwards of $5,000-10,000 without insurance
That was maybe 10+ years ago. I would expect a minimum of $15,000 for a normal vaginal birth in a hospital/facility. That's about the going rate in the midwest - out in DC, I would think it would be more.
The whole midwife thing can be iffy. In Minnesota, there is a licensure/certification for Certified Nurse Midwife and insurance covers them. If you're thinking more of a Doula type, where there is no accredited certification and is more of a holistic type of thing, then there would be no coverage for sure.
You will need to get more information about the laws in your area regarding licensed health care providers. The term "midwife" can mean a variety of different things.
I should add that there are costs for you in the hospital and costs for the new baby in the hospital - that estimate includes both. Check with your current insurance about how/if the newborn charges are covered even if your delivery charges are not.
posted by thatguyjeff at 7:33 AM on February 8, 2013
That was maybe 10+ years ago. I would expect a minimum of $15,000 for a normal vaginal birth in a hospital/facility. That's about the going rate in the midwest - out in DC, I would think it would be more.
The whole midwife thing can be iffy. In Minnesota, there is a licensure/certification for Certified Nurse Midwife and insurance covers them. If you're thinking more of a Doula type, where there is no accredited certification and is more of a holistic type of thing, then there would be no coverage for sure.
You will need to get more information about the laws in your area regarding licensed health care providers. The term "midwife" can mean a variety of different things.
I should add that there are costs for you in the hospital and costs for the new baby in the hospital - that estimate includes both. Check with your current insurance about how/if the newborn charges are covered even if your delivery charges are not.
posted by thatguyjeff at 7:33 AM on February 8, 2013
Response by poster: To clarify, I have insurance, but it doesn't currently cover maternity. From what I understand, that means I would still qualify for the insurer's negotiated rates. Am I wrong about that?
posted by crunchysalty at 7:34 AM on February 8, 2013
posted by crunchysalty at 7:34 AM on February 8, 2013
Maybe, maybe not. If your insurance co. actually told you that, it's probably true.
The difference is whether it's not covered/excluded or it is covered, but you pay 100% coinsurance.
If you have a booklet which explains your coverage, see what it says about maternity. If it notes it as not covered, excluded, ineligible, etc. you are on the hook for the billed charge, not the negotiated rate.
posted by thatguyjeff at 7:38 AM on February 8, 2013
The difference is whether it's not covered/excluded or it is covered, but you pay 100% coinsurance.
If you have a booklet which explains your coverage, see what it says about maternity. If it notes it as not covered, excluded, ineligible, etc. you are on the hook for the billed charge, not the negotiated rate.
posted by thatguyjeff at 7:38 AM on February 8, 2013
"3. We're very interested in going the midwife route. Are there options for insurance or something similar for this? Are we better off just starting a savings account now?"
What thatguyjeff said about midwives (and as you're in DC, probably you have VA, MD, and DC providers to look at). I attend an ob/gyn practice with both doctors and midwives, and I think this is pretty ideal. You can choose midwife care if that's what you want, but if you have a complicated pregnancy, you can see a doctor with no disruption in care. If you have small problems that require a doctor, you can just see the doctor now and then while remaining under the primary care of the midwife; if you have a big problem, you can switch over with no problem. I think people often aren't aware this sort of option exists, but it is pretty great.
If it helps you decide, my practice charges a lump sum for prenatal care, which covers all visits (routine check-ups, problem visits, phone access), but not tests (sonography, blood tests, etc.). I'm in a pretty inexpensive area (my C-section ran about $11,000 for me and a further $5k for the child, IIRC, at the insurer's negotiated rates), and the lump sum for prenatal care was about $3200. Don't forget to factor prenatal care into your calculations!
(I also had to go to the emergency room three times during my second pregnancy -- twice for rehydration therapy for hyperemesis gravardium, once for pneumonia -- and that adds up fast. Check if your non-maternity policy would cover ER visits caused by pregnancy.)
posted by Eyebrows McGee at 7:44 AM on February 8, 2013
What thatguyjeff said about midwives (and as you're in DC, probably you have VA, MD, and DC providers to look at). I attend an ob/gyn practice with both doctors and midwives, and I think this is pretty ideal. You can choose midwife care if that's what you want, but if you have a complicated pregnancy, you can see a doctor with no disruption in care. If you have small problems that require a doctor, you can just see the doctor now and then while remaining under the primary care of the midwife; if you have a big problem, you can switch over with no problem. I think people often aren't aware this sort of option exists, but it is pretty great.
If it helps you decide, my practice charges a lump sum for prenatal care, which covers all visits (routine check-ups, problem visits, phone access), but not tests (sonography, blood tests, etc.). I'm in a pretty inexpensive area (my C-section ran about $11,000 for me and a further $5k for the child, IIRC, at the insurer's negotiated rates), and the lump sum for prenatal care was about $3200. Don't forget to factor prenatal care into your calculations!
(I also had to go to the emergency room three times during my second pregnancy -- twice for rehydration therapy for hyperemesis gravardium, once for pneumonia -- and that adds up fast. Check if your non-maternity policy would cover ER visits caused by pregnancy.)
posted by Eyebrows McGee at 7:44 AM on February 8, 2013
Best answer: Can you wait until next year? Private insurance will be required to cover maternity as of Jan 1, 2014.
posted by Oktober at 7:44 AM on February 8, 2013
posted by Oktober at 7:44 AM on February 8, 2013
Best answer: One thing you want to pay a lot of attention to is whether (and how high) the "lifetime maximum benefit" is for maternity in any maternity policy or rider that you sign up for. There was an article in the Washington Post about five years ago that talked about the shortcomings of these plans that tend to leave women much less covered than you would expect. As I recall (and I'm sorry that I can't find the article now!), one of the major issues was that stand-alone maternity policies capped their total payout at something like $10,000--including all prenatal care, hospital charges, and physician charges for delivering the baby--and so women paid a bunch of premiums for these policies and then had a lot of expenses after the birth anyway.
Another thing to keep in mind is that any individual policy you buy through the new health insurance exchange after January 1, 2014 will have to cover maternity benefits as a core benefit, and will not be able to exclude coverage for pre-existing conditions (like pregnancy). So if you are planning on starting to try to get pregnant only at the end of the year, you probably don't need to bother with getting a maternity policy now so long as you're okay signing up for a new plan / new policy at the beginning of next year. The downside here is that it's a bit unclear how expensive policies in the new exchanges will be--they'll have much better benefits (at least some sort of maternity, mental health) but that's more expensive. Staying in your current policy will probably allow you to keep a much lower premium as you're grandfathered in.
posted by iminurmefi at 7:46 AM on February 8, 2013
Another thing to keep in mind is that any individual policy you buy through the new health insurance exchange after January 1, 2014 will have to cover maternity benefits as a core benefit, and will not be able to exclude coverage for pre-existing conditions (like pregnancy). So if you are planning on starting to try to get pregnant only at the end of the year, you probably don't need to bother with getting a maternity policy now so long as you're okay signing up for a new plan / new policy at the beginning of next year. The downside here is that it's a bit unclear how expensive policies in the new exchanges will be--they'll have much better benefits (at least some sort of maternity, mental health) but that's more expensive. Staying in your current policy will probably allow you to keep a much lower premium as you're grandfathered in.
posted by iminurmefi at 7:46 AM on February 8, 2013
Just FYI, there may be exceptions to this but generally the cost for C section and vaginal birth are equal. There is a myth that docs do more C sections to make more money but it really isn't that different. The difference would be that with C section you usually stay in the hospital for an extra night (which can be pricey) and you could have post-surgical complications (rare) that would cost more.
I'd agree with Oktober, wait until maternity is covered. I'm due this week and the costs really really add up.
posted by treehorn+bunny at 7:48 AM on February 8, 2013
I'd agree with Oktober, wait until maternity is covered. I'm due this week and the costs really really add up.
posted by treehorn+bunny at 7:48 AM on February 8, 2013
Response by poster: Thanks for all the answers, everyone. I was concerned about the maternity riders being essentially useless as far as coverage. With all the information you've (already!) given us, we'll probably wait until 2014, and look into a combined medical/midwife options in the meantime. You guys are the best!
posted by crunchysalty at 7:54 AM on February 8, 2013
posted by crunchysalty at 7:54 AM on February 8, 2013
It might really be worth it for one of you to consider taking a job with coverage through your employer, if only for a few years and if at all possible.
posted by WeekendJen at 7:55 AM on February 8, 2013
posted by WeekendJen at 7:55 AM on February 8, 2013
Off topic, but check out the GW Midwives practice when you're ready!
posted by semacd at 8:17 AM on February 8, 2013
posted by semacd at 8:17 AM on February 8, 2013
My c-section with my son in 2007 at a nationally know hospital ( blue cross rate ) was 7140. Just saying.... I had insurance and didn't pay a thing but it wasn't astronomical.
posted by pearlybob at 8:32 AM on February 8, 2013
posted by pearlybob at 8:32 AM on February 8, 2013
we'll probably wait until 2014
You will probably not be the only one. There will probably be a lot of babies in feb and march 2014. You may want to keep that in mind when planning.
posted by DreamerFi at 9:35 AM on February 8, 2013
You will probably not be the only one. There will probably be a lot of babies in feb and march 2014. You may want to keep that in mind when planning.
posted by DreamerFi at 9:35 AM on February 8, 2013
I live in the "other" Washington and buy my health insurance privately. Once we were ready to start a family, I upgraded my health insurance plan to the version that included maternity coverage. The price difference was about what you outlined above. It wasn't really so much like purchasing an additional rider to the insurance -- as one would add to a homeowner's policy to cover some rare artwork -- but switching from one plan to another. (I stayed with the same insurance company.) From my point of view, it functioned exactly as an employer-sponsored plan would. (I have professional experience dealing with health insurance on the employer side.) There were no "gotchas" - the premium, co-insurance, lifetime maximums, and annual out-of-pocket limits were all clearly defined.
I basically have an 80/20 plan. After I meet the deductible, insurance picks up 80% and I pick up the other 20% (until I reach the annual cap on out-of-pocket). Yes, the monthly premium for maternity coverage was high, but it's small compared to the cost of maternity care.
For the birth of my daughter, we opted to go with the nurse-practitioner midwifery practice affiliated with a local hospital system. The cost for the midwife was predictable, as they basically had a flat rate that covered the standard set of appointments and a delivery fee. But there were a number of other costs associated with prenatal care and the birth that weren't as predictable. And I went past my due date so I ended up having appointments every other day for a week, not covered by the flat rate. So it adds up even before you get to the hospital. And this is really the point where it's truly insurance and not just pre-paid medical care -- you don't know for certain what medical care you will need for your pregnancy.
All that said - DC may be different. Washington State is relatively consumer-friendly when it comes to health insurance. Read through the coverage you are being offered. Before I decided on a plan I got a ballpark figure for an easy hospital birth in our area, and then calculated out my potential responsibility under different plans in Excel. Then I decided how much financial risk I was willing to take.
posted by stowaway at 11:25 AM on February 8, 2013
I basically have an 80/20 plan. After I meet the deductible, insurance picks up 80% and I pick up the other 20% (until I reach the annual cap on out-of-pocket). Yes, the monthly premium for maternity coverage was high, but it's small compared to the cost of maternity care.
For the birth of my daughter, we opted to go with the nurse-practitioner midwifery practice affiliated with a local hospital system. The cost for the midwife was predictable, as they basically had a flat rate that covered the standard set of appointments and a delivery fee. But there were a number of other costs associated with prenatal care and the birth that weren't as predictable. And I went past my due date so I ended up having appointments every other day for a week, not covered by the flat rate. So it adds up even before you get to the hospital. And this is really the point where it's truly insurance and not just pre-paid medical care -- you don't know for certain what medical care you will need for your pregnancy.
All that said - DC may be different. Washington State is relatively consumer-friendly when it comes to health insurance. Read through the coverage you are being offered. Before I decided on a plan I got a ballpark figure for an easy hospital birth in our area, and then calculated out my potential responsibility under different plans in Excel. Then I decided how much financial risk I was willing to take.
posted by stowaway at 11:25 AM on February 8, 2013
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Do the math.
posted by valkyryn at 7:12 AM on February 8, 2013 [1 favorite]