Maternity insurance under Obamacare (Affordable Care Act) allows parents to purchase individual coverage. However, holes remain with paid leave, large deductibles, and open enrollment waiting periods.
Parents can find an individual plan that covers prenatal care, hospitalization, and newborn care. Already pregnant women can get insurance without fear of rejection. Break down the issues into three main topics, and find ways to fill common holes.
- Paid maternity leave coverage
- Coverage requirements for essential benefits and deductibles
- Waiting period for preexisting pregnancies and open enrollment
Obamacare Maternity Leave Coverage
Obamacare maternity leave does not exist anywhere in the very lengthy law. The regulation addresses healthcare programs that directly reimburse doctors and hospital after providing medical care. Replacing income requires payments to the individuals who stop working. It is completely different.
Private options and subsidy payments do provide some assistance for couples who stop working and lose income.
Paid Maternity Leave
The Affordable Care Act does not provide paid maternity leave benefits. Supplemental health insurance helps couples achieve this objective. The policies provide income support when mom delivers her baby in the hospital, and while she is recovery from childbirth. Purchase the policies prior to conception, and get them at work via voluntary employee benefits.
Maternity Leave Assistance
The Affordable Care Act does provide payment assistance that makes having a baby more reasonable before and after maternity leave. Government subsidies are available to help lower premium costs, and total out of pocket medical costs. The subsidies are based upon your household income relative to the Federal Poverty Level (FPL). Families with incomes below four hundred percent of FPL may qualify for assistance.
If your employer offers a qualified plan, you do not qualify for a subsidy, even if your family income falls into a qualifying range.
Obamacare Maternity Coverage Requirements
Obamacare maternity coverage requirements do many things to expand options for families having children. Riders have gone away! Couples can now purchase individual plans through their state insurance marketplace that provide ten essential health benefits.
Deductible requirements have special meaning to couples birthing children. They expect to utilize the healthcare system more heavily than the average person, which may affect their best plan design choice.
Essential Maternity Benefits
The Affordable Care Act requires three essential maternity benefits. Any plan sold to individuals, or small groups of fifty or fewer employees, must provide ten different essential health benefits. Coverage for prenatal care, hospitalization for labor and delivery, and newborn care are three of the listed benefits.
Maternity deductibles under the Affordable Care Act should make couples think about utilization, cost benefit ratios, and network hospitals. Individuals and employees of small businesses can choose between five standardized plan choices. They have convenient “metal” labels with corresponding deductibles, actuarial values, and premium costs.
Actuarial value is the expected amount of in network medical expenses the plan will cover for all members. For example, an average family selecting the bronze level would expect to have left over medical bills representing 30% of their utilization.
Expectant parents are not average. Their utilization will be far higher. This radically changes the best choice. The ratio of expected cost to expected value is very different.
Health plans will have a wide variety of in network providers. One key consideration is finding whether the top children’s hospitals in your state participate in the network. If your local hospital NICU unit is out of network, you may experience a nasty surprise.
Obamacare Maternity Waiting Periods
Obamacare maternity waiting periods sound good at first glance. However, lurking just beneath the surface are several hidden rules that can catch unlucky couples who choose to opt out, or buy a cheaper plan with a lower actuarial value.
The good news is that the law provided enhanced rights for people with preexisting medical conditions. However, the open enrollment rules may preclude many expectant women from taking advantage.
The Affordable Care Act allows women to purchase maternity insurance with no waiting period. Healthcare plans must immediately cover preexisting conditions with no waiting period before benefits begin. Carriers cannot turn down applications because of preexisting conditions.
Expectant women can purchase coverage without any exclusions. It would make great sense to do so, as hospital delivery is often the most expensive stage of your pregnancy.
Open Enrollment Timeframes
The Affordable Care Act maternity coverage open enrollment requirements counterbalance the no waiting period requirements noted above. Open enrollment begins on November 15, and concludes on February 15 of the subsequent year.
Open enrollment lasts just three months. Most pregnancies conceive and deliver inside a nine-month period. That means that three quarters of women who opt out and then become pregnant, will be unable to opt back in before they deliver. Conception is not a qualifying life event.
Couples who do have a policy in place may qualify to make changes outside of open enrollment. They may experience a qualifying life event if mom loses health insurance while disabled due to pregnancy complications. The birth of a child is also a qualifying life event. Couples can change their plan choice to include infant coverage.