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Maternity Coverage Proves Costly For Women Buying Individual Policies

Pregnancy ranks right up there with diabetes and a bad heart as a medical condition you don't want to have if you're in the market for individual insurance coverage.

As a recent investigation by the House Energy and Commerce Committee found, chances are your policy won't cover expenses related to maternity care unless you buy a special maternity rider before you get pregnant and pay a hefty premium surcharge.

How much? Try $400 a month. And that's just the start when it comes to extra charges.

While pregnancy is generally a nine-month proposition, post-partum care adds another couple of months to the total. That means many women need maternity coverage over two health plan years, with the result that they may have to pay two separate deductibles for their maternity coverage.

"It’s amazing how many costs a person might face, even with insurance," says Lisa Codispoti, senior counsel at the National Women’s Law Center, which has also investigated maternity coverage in the individual market.

In a memo outlining the results of its investigation into insurance company practices, the Energy and Commerce committee described a proposed maternity rider, for example, that would have imposed a $5,000 annual deductible on the costs of maternity care. A typical uncomplicated pregnancy, including prenatal and postpartum care, cost $10,652 in 2007, according to the March of Dimes.

Additional maternity rider costs would come on top of other common restrictions, including waiting periods of one or two years and limits on total benefits of a few thousand dollars in some cases.

In a few years, none of this should still apply. Under the federal health overhaul, maternity care is considered an essential health benefit, and insurance companies that sell policies in the state-based insurance exchanges, as well as those that sell new individual and small group policies outside the exchanges, will have to provide maternity coverage.

Until then, if you have individual coverage you may want to get cracking now in the hope of confining your pregnancy costs to the upcoming calendar year.

Copyright 2023 Kaiser Health News. To see more, visit Kaiser Health News.

Michelle Andrews