Individual Maternity Insurance Coverage

Individual maternity insurance coverage is an option for couples who don’t have employer sponsored health plans. But individual maternity coverage is hard to find: insurers know that you are planning to use the benefit.

If you are already pregnant and need insurance you will have to be creative.  Pregnancy is a pre-existing condition for any individual maternity plan. Government programs often help. 

Insurance companies want to take in more in premium than they pay out in benefit.  Therefore, they will offer individual maternity policies in one of three ways: when compelled by state law, with long waiting periods, or with big deductibles. 

• Know State Laws: Does your state mandate maternity coverage?
• Define Coverage Holes: How maternity rider deductibles and waiting periods work
• Fill Gaps: with supplemental maternity coverage available in every state
  
  

Eighteen states mandate maternity coverage.  Some mandate coverage, while others require only that insurers offer a plan with maternity benefits.  Some state maternity mandates apply to individual policies, while others apply only to small group coverage.  Know the rules in your state.

Individual maternity health insurance is your next option if you can't get coverage through an employer. Many employers choose not to offer health insurance because there is a direct cost: insurers require that employers pay a percentage of the premium.

Without a federal law mandating coverage for pregnancy and maternity in the individual market insurers allow adverse selection to drive their benefit offerings.  Adverse selection suggests that couples planning a pregnancy cost far more to insure, and are far more likely to buy coverage.

Health insurance companies protect themselves from adverse selection by offering maternity riders.  Maternity riders are an optional benefit to cover your normal pregnancy, maternity, and delivery.  Since insurers know that you plan to use the benefit, they structure the rider in a way that brings in more premium than they pay in benefits: long waiting periods, and large deductibles.

For couples looking to get pregnant very soon, a maternity rider with a one year waiting period doesn't fit.  Plans with a large deductible often mean paying more in extra premium than you might ever receive in benefits.

Complications of pregnancy will be covered provided your health insurance coverage begins before getting pregnant.  But how can you afford all the other costs?  

Supplemental maternity insurance provides a solution that fills holes in many individual maternity insurance plans.  There are no waiting periods to satisfy before getting pregnant, and no deductibles to meet before benefits begin.  Normal pregnancy is covered, along with complications, and premature birth.