First off, congrats!! Very exciting!
We hope and pray for a smooth pregnancy and arrival for your new baby.
Choosing a health plan when you're having a baby is actually pretty easy. Here's what you need to do:
- Make sure your OBGYN and hospital you're delivering at are "in-network". You can use our doctor search tool or in this case, it's also worth calling and talking with your doctor's office.
- Find a plan that minimizes the following equation:
Cost of baby = Monthly premiums x 12 + max-out-of-pocket limit
Let's break that down a little bit:
The max-out-of-pocket limit is the most you'll pay in a given year before you pay no more for covered services. For most plans in your area, it probably ranges between $3,000-$7,000 for each individual. For example, if your plan's max-out-of-pocket limit is $5,000 and you get a $100,000 bill, you pay $5,000 and not a penny more as long as the charge was for a covered service (having babies are covered) and the provider was in-network (back to step 1 above).
You will almost certainly reach your max limit when you have a baby: The full cost for having a baby in the US ranges between $20,000-$60,000 for regular deliveries and $40,000-$100,000 for c-section deliveries. Your prenatal care is going to cost $2,000-$6,000. This only goes up if there are any complications or additional treatments needed.
The mistake many people make is they forget about the Premium component of the equation above. They assume they will need a Gold or Platinum plan when they are having a baby because those plans will cover more costs up front. This is true, but you may still end up paying more in the long-run. Depending on the plans in your area, a Bronze plan may actually be better. You just have to see. Consider this example:
The numbers above are typical and will vary in your area, but let's play this out:
For the Bronze plan: Cost of baby = $250 x 12 + $6,000 = $9,000
For the Gold plan: Cost of baby = $600 x 12 + $3,000 = $10,200
You've probably noticed by now that having a baby is going to be expensive, that's just the reality when you're on insurance in the individual market and don't have a company helping you pay. On the other hand, you can save $1,000s by planning smart and of course having insurance still is a good choice if you're expecting (you definitely don't want to pay the full-price cost).
On our survey, you can tell us you're expecting a baby by typing "have a baby" or "pregnant" on the condition search and we'll run the numbers above for you with the plans in your area.
A few other notes that'll help you:
- The baby is covered under the mother's insurance for the first 15-30 days of his or her life, depending on the state you're in. Make sure once your baby comes, you call your insurance company to add him or her within 15-30 days!
- Don't get wrapped up in "family" deductible and out-of-pocket-max amounts. The baby counts as the mother, so you'll just be liable for the mother's deductible and max-out-of-pocket.
- For the mom's prenatal care and delivery, some doctors and hospitals will charge one lump sum and others will charge by doctor visit. It usually doesn't make a big difference cost-wise unless your pregnancy crosses over a calendar year--which could technically make you liable for 2 deductibles and max-out-of-pocket limits (please, try not to have your baby on New Year's Eve ;)