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How to get maternity health insurance quotes Posted: September 20th, 2010

By Megg Mueller

For those not covered under group health insurance, maternity coverage can be difficult to find. Plan options vary widely, so before you decide to get pregnant do your research.

How to get maternity health insurance quotes

Most women in the U.S. give birth. In fact, by the time they reach age 44, 85 percent of American women will give birth to a baby, according to a report by the Centers for Disease Control. While childbirth is clearly a common occurrence, only 13 percent of individual health plans available to a 30-year-old woman provide maternity coverage. This disconnect is one that legislators and women's advocacy groups are working to change.

While most insured people get their health insurance through group plans offered by employers, there are 14 million people under age 65 who buy individual insurance coverage, the Kaiser Family Foundation reports. For those who are pregnant or considering pregnancy and looking for individual coverage, the options are limited.


Recent study confirms lack of individual maternity coverage

The National Women's Law Center (NWLC) is an organization that is pushing for reform of maternity coverage for health insurance plans, among other women's issues. In its 2009 report, "Still Nowhere to Turn," the NWLC examined more than 3,600 individual health insurance policies offered to 30-year-old women living in capital cities across the country. It was discovered that only 468 of those plans--or 13 percent--include any coverage for maternity care.

Brigette Courtot is co-author of the report and senior health policy analyst for the NWLC. She says the NWLC knew there was a problem with coverage when they started conducting their research, but even they didn't realize the extent of the problem.

"It's virtually impossible to get this kind of coverage in this individual market. It's a shocking gap in maternity coverage," she says. "We have laws that employers of a certain size have to offer you maternity coverage, and that's the way the majority get coverage is through their job. Unless you've looked into this, you might make the assumption (individual health care) works the same way."

Health care plans vary wildly from company-to-company, and from state-to-state, and there are plans that offer maternity coverage, usually in the form of a "rider" or addition to a policy. Most of these riders come with heavy restrictions, along with additional fees. It's common for maternity coverage to include a waiting period, often 12 months, before benefits kick in. In some cases, deductibles have been as high as $10,000, and women who thought they were adequately covered found that the policy contained a cap of only a few thousand dollars, hardly enough to pay for the cost of a normal delivery without complications.

"A lot of these plans have these have really big restrictions, like a $2,500 annual cap, and a waiting period. Our conclusion about the riders is they weren't a good option. They may be the only choice, but they are a bad deal," Courtot says.

Some health insurance companies don't offer individual health insurance policies with maternity coverage, whereas other insurers only offer plans in a handful of states. "There are two things that insurance companies really hate: cancer and pregnancy. They can't really sell policies that decline to cover cancer, but they can refuse to cover maternity," says Judy Dugan, research director at Consumer Watchdog.

What's a woman to do?

Even a bad rider or inadequate health plan might sound like better than nothing to someone seeking maternity coverage on the individual market. So what are the options for maternity care if you're not covered under a group health plan? Here are a few suggestions from Courtot:

  • Do your homework thoroughly when researching and choosing an individual health plan. An online search to compare health insurance quotes can provide a good starting point for what's available in your state. Contacting a broker you have a relationship with is another good step. Read the fine print, and then the fine, fine print of any health insurance policy so that you are aware of any restrictions that could make the plan virtually unusable.
  • If you qualify, apply for your state Medicaid program. "The states have picked up the slack," Courtot says. "But you have to have the income qualification. It's a double-pronged test; first is income level, then whether you fall into a designated category (i.e., children, parents with dependent children, pregnant women, etc)."
  • Try to negotiate a discount with your local hospital or birthing center for your maternity care and delivery. This is sometimes the only option for women who can't qualify for Medicaid, but don't have coverage.
  • For women who are self-employed, Courtot notes, an option might be to consider going back to a job with an employer that offers a group plan.
  • In July 2010, high-risk pools must be established by every state per the health care reform law. To qualify, you have to have been unable to get coverage due to a pre-existing condition or have been uninsured for 6 months. However, Courtot cautions that there has not been a lot of detail on whether or not these plans will cover maternity care. Some states will run these pools, while others have opted to let the federal government run them. Without a single entity running the high-risk pools, a large discrepancy in what benefits are offered could emerge. Federally run plans may be more likely to offer maternity coverage.

Make sure you plan ahead

Many of these tips apply only if you are not currently pregnant. If you are already pregnant, these may not be viable options. Pregnancy is considered by insurers to be a pre-existing condition, and you will therefore be considered uninsurable.

"It is virtually impossible to get coverage if pregnant," Courtot says. "You can find a health plan, but not the pregnancy coverage."

"It's not so much the cost of pregnancy they want to avoid, but the possibility of a sick baby, one that might need costly care for years, or tens of thousands of dollars worth in the first days of life," Dugan explains. "Insurance companies want to 'kick the tires' on a child before they agree to sell the family insurance coverage."

There is light at the end of the tunnel, however. The Health Care Reform Act provision that forbids insurance companies from rejecting applicants due to a pre-existing condition goes into effect in 2014. This is also the time when health care exchanges are due to be operational, which could mean cheaper, more comprehensive coverage available for those buying individual health insurance. That's a long time to wait, but if the option is there, it's worth considering.