Texas maternity health insurance for individuals has changes beginning January 1, 2014. The Affordable Care Act (Obamacare) makes maternity riders a thing of the past. Families no longer have to choose between plans with long waiting periods and/or large deductibles.
Individual maternity insurance in Texas will soon be available without riders. You can purchase private plans, and may get assistance with premiums and out of pocket costs. Pregnant women can purchase a policy with limitations.
The issues are outlined below:
- Where to get quotes
- How to choose the right plan
- Women who are already pregnant
Texas Maternity Health Insurance Quotes
The first thing many people want to know is what maternity health insurance covering maternity costs in Texas. Don’t just get a quote and pick the cheapest plan.
Look at what the plans cover and project what your costs for prenatal care, hospital delivery, and newborn care might be. Also look closely at the network of doctors and hospitals included in the plan. Make sure there is a level four NICU unit included in network in case your child is born prematurely, or with a serious illness.
Quotes with Expert Advice
Licensed insurance agents have the most experience dealing with health insurance plans covering maternity in Texas. Yes the rules have changed, but agents familiar with how insurance works are best positioned to provide competent assistance.
Many agents can also assist you in determining any premium and cost sharing subsidies.
Quotes for Low Income Texans
The Texas health insurance exchange is the second option for getting quotes. Here you are on your own to navigate the government online system. You need to visit the Texas state health insurance exchange to get cost information. You need to navigate through a series of screens covering:
- The Texas county where you reside
- Who is applying for coverage: individual, family, husband and wife, parent and child, and child only
- A summary of essential health benefits
- Income ranges that may qualify for premium and cost sharing subsidies
- Five plan categories with covering specific percentage of claims
Navigators are available to provide assistance, but unlike licensed agents these are mostly volunteers with little health insurance experience or knowledge. Navigators must pass a certification exam. Texans with low incomes can easily determine their level of subsidy using the healthcare.gov site.
Choosing Private Maternity Insurance in TX
When choosing private health insurance covering maternity in Texas and any other state there are two key considerations: adverse selection, and premiums taxation.
Maternity Adverse Selection
When choosing a health insurance plan covering maternity keep in mind that you plan to use the benefit. Insurance companies refer to this as adverse selection. A normal vaginal delivery can cost the insurance company $12,000. A c-section delivery cost more, and a premature birth skyrockets costs.
When choosing between the five metal plan levels keep in mind that your projected out of pocket costs will probably be much higher. Here are sample quotes for the lowest cost plan in each of the five levels for a parent child plan in Dallas County Texas:
|Level||Actuarial Value||Monthly Premium Cost|
How do you decide which plan works best? Do you want a volunteer or an expert helping you make the choice? You pay approximately $100 per month more for a plan with an actuarial value that is 10% better. Is it worth the extra money when you plan to use the benefit?
Out of Pocket Exposure
The answer depends upon what it might cost to deliver your baby, and what each plan might leave in unpaid expenses. Each plan has an out of pocket maximum which the government site does not display. The ACA limits out of pocket expenses to $6,350 for an individual and $12,700 for a family.
The incremental annual cost seems to be roughly $1,200 to eliminate 10% of actuarial risk. Look at four possible maternity outcomes. Only the vaginal delivery option does not pay to upgrade. Buy the best plan – Gold.
|Delivery Type||Estimated Cost||10% Actuarial Savings|
Self employed workers may have a different consideration than an individual. Self employed workers get a tax break on the premium costs. This makes upgrading the plan level even more favorable for maternity care considerations.
The IRS allows self employed workers to use the cost of individual health insurance to reduce business income. See Schedule C, Part II, Line 15. Consult your tax advisor.
Small businesses can also get quotes on the healthcare.gov site. Or you can work with an agent experienced in these matters. Remember that small business health insurance premiums remain a deductible business expense.
Employees electing coverage can use pre tax elections to reduce their reportable W2 income. They save on federal, state, and FICA taxes. When purchasing coverage as an individual they lose this advantage.
Texas Women Already Expecting
Women who are currently pregnant can enroll in a health care plan covering maternity during open enrollment. Preexisting pregnancies can no longer be excluded. Your pregnancy will be covered beginning on the effective date of coverage.
Medicaid in TX is a government sponsored health insurance option for low income citizens and pregnant women. Funding is shared between the federal government and the state of Texas.
Women must meet income and resource guidelines to qualify. The income limit is set by Texas at 185% of the federal poverty level. This comes to about $27,000 for a couple based upon 2010 published guidelines. Resources, or assets in your name, are capped at $2,000 after exclusions for an individual, and $3,000 after exclusions for a couple. Exclusions are: one car, a home valued less than $500,000, a burial plot, and a life insurance policy with up to $1,500 of cash value.
If you are currently expecting and believe you meet the qualifying criteria for coverage you will need to complete an application form and provide several documents the agency will use to verify your eligibility:
- Proof of income: your last three paychecks
- Proof of citizenship: passports, birth certificate, naturalization papers, etc
- Healthcare statements: evidence of any outstanding financial obligations tied to your condition
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