If you're expecting a baby, one of the most important factors when choosing a health insurance plan is your total expected annual cost, including both monthly premiums and out-of-pocket expenses.
What should I consider when choosing a plan during pregnancy?
When comparing plans, focus on:
Whether your OB-GYN is in-network
Whether your preferred hospital is in-network
Your monthly premium
Your deductible
Your maximum out-of-pocket limit
Because pregnancy, delivery, and newborn care often result in significant healthcare expenses, many families reach a large portion of their deductible or out-of-pocket maximum during the year.
How do I compare plan costs?
A simple way to compare plans is to estimate your total annual healthcare costs:
Estimated Annual Cost = Annual Premiums + Maximum Out-of-Pocket Limit
For example:
Plan Type | Monthly Premium | Annual Premium Cost | Maximum Out-of-Pocket | Estimated Maximum Annual Cost |
Bronze Plan | $250 | $3,000 | $6,000 | $9,000 |
Gold Plan | $600 | $7,200 | $3,000 | $10,200 |
The plan with the lower out-of-pocket maximum is not always the least expensive overall. Comparing both premiums and cost-sharing can help you identify the most cost-effective option.
How do I verify my doctor and hospital are covered?
Before enrolling, confirm that:
Your OB-GYN participates in the plan network
Your delivery hospital participates in the plan network
Any specialists you expect to use are in-network
You can use provider search tools or contact the provider's office directly to verify participation.
What happens after my baby is born?
The birth of a child creates a Special Enrollment Period (SEP), allowing you to update your health insurance coverage outside of Open Enrollment.
After your baby is born:
Notify your insurance carrier or benefits administrator as soon as possible.
Add your child to your health insurance plan within the required enrollment window.
Review any premium or coverage changes that result from adding a dependent.
Missing the enrollment deadline may delay coverage for your child.
Will my deductible and out-of-pocket costs change after my baby is born?
This depends on your plan design.
Some plans have separate individual and family deductibles and out-of-pocket maximums. Review your plan documents carefully to understand how costs are calculated for maternity care and newborn coverage.
What if my pregnancy spans two calendar years?
If prenatal care and delivery occur in different plan years, you may be responsible for cost-sharing in both years.
For example:
Prenatal care may apply toward one year's deductible and out-of-pocket maximum.
Delivery and hospital expenses may apply toward the next year's deductible and out-of-pocket maximum.
If your pregnancy is expected to span two calendar years, compare plan options carefully and review how deductibles reset at the beginning of the new plan year.
How can Take Command help?
When shopping for coverage through Take Command, you can indicate that you are pregnant or expecting a baby. This helps identify plans that may be a good fit based on your expected healthcare needs and provider preferences.
Key takeaway
When choosing a health plan during pregnancy, prioritize in-network providers and compare the total annual cost of each plan, including both premiums and out-of-pocket expenses.