Shopping for Health Insurance with Future Pregnancy in Mind

Why your health plan matters during pregnancy

Pregnancy may cause your health care needs to change as the trimesters fly by. If you’re someone who finds themselves falling behind on their annual physical, you may be going to the doctor more than you ever have before. Most guidelines suggest seeing your doctor at least once a month through the first 28 weeks and even more often after that¹. That’s why it’s so important to understand your insurance coverage before unexpected expenses arise.

Understanding health insurance during pregnancy

Without insurance, delivery alone can cost anywhere from $11,500 to $17,000². Luckily, most insurance plans have robust benefits that can help bring your total costs down. Your insurance plan’s coverage for maternity-related costs is often listed in the documents you received when your plan started.

Essential benefits for healthcare during pregnancy

Most plans, including employer-sponsored and those purchased through your state’s Affordable Care Act (ACA) marketplace, will cover essential procedures related to pregnancy². This can include delivery, prenatal checkups, screenings, and breastfeeding support².

How deductibles, copays, and out-of-pocket maximums apply

Even if your plan covers maternity care, you may still have to pay out-of-pocket for certain procedures. There are three key insurance concepts to understand:

• Deductible: The amount you pay out-of-pocket before your insurance begins to pay for care.³
• Copay: The fixed amount you pay at the time of service once you’ve met your deductible.⁴
• Out-of-pocket maximum: The maximum amount you pay for health care each year, according to your plan.⁵

Knowing your deductible can help you estimate how much you can expect to pay. For example, if you have a plan with a $3,000 deductible, you’ll have to pay at least that amount in service, hospital, and prescription fees before your health plan pays 100% of the costs of covered benefits.

Provider networks and hospital coverage

Typically, every insurance company has a preferred network of providers, hospitals, and care centers with whom they’ve negotiated prices. It’s important to do your research and confirm your providers are in network. Some insurance plans only cover in-network treatment or have higher deductibles and out-of-pocket maximums for out-of-network care.

You may encounter situations where you visit an in-network hospital but are treated by an out-of-network provider. This makes it especially important to check the network status of any physician you see. However, the 2022 No Surprises Act protects patients from surprise billing when being treated by an out-of-network provider during emergency and non-emergency services at an in-network facility⁶.