How much does a maternity insurance policy cost per month? The answer varies widely, as there are many different plan designs, and the government may chip in with subsidies that vary by household income, and state of residence.
Rather than focusing exclusively on the monthly premiums that you must pay for prenatal care, consider what the plan covers for labor and delivery as well. Most of your expenses occur during your hospital stay. Break the problem down into two parts.
- Determining monthly premium amounts
- Average prenatal care, labor and delivery expenses
Determining Maternity Insurance Cost per Month
The first step, determining maternity insurance premium costs per month, is not always simple. You have different plans to choose between, and you may be eligible for subsidies from your employer and the federal government that makes the programs more affordable.
Begin by requesting a quote, but also, take the time to examine some example figures, which illustrate how the different subsidy programs may apply to your situation.
Maternity Insurance Quotes
Request a healthcare quote for a plan covering maternity. An agent will contact you to provide you with estimates of monthly premium rates for several plan designs in your area. The agent may be able to assist you in determining whether you qualify for subsidies and help you select the plan design that best suits your needs.
The online form will ask you if you have experienced a major life event in the last thirty days. If you answer yes, you may be eligible to purchase health care outside of open enrollment. Otherwise, you may have to wait until January 1 for coverage to begin.
Maternity Insurance Cost Examples
There is no such thing as a reliable maternity insurance cost example. Too many variations apply uniquely to certain population segments. An example figure would not provide an accurate answer. However, a brief overview of each segment can help you narrow down where you might fit.
Employer-based group plans cover maternity by law. Many employers pay a significant portion of the premium on behalf of each participant. In addition, W2 employees can pay the remaining monthly premiums using pre-tax payroll deductions, which reduce the amount of income tax you owe.
Monthly premiums vary based on the type of plan you select. For example, in the individual market, you choose between a platinum, gold, silver, or bronze plan.
- A platinum plan covers 90% of projected health care utilization and has the highest premium.
- A bronze plan covers only 60% of projected health care utilization and has the lowest premium.
The government provides premium and expense sharing subsidies based upon household income as a percentage of the Federal Poverty Level (FPL). The premium subsidies reduce what you pay based upon a percentage of income while the expense sharing subsidies reduce your out-of-pocket spending (actuarial value) of a silver plan when you utilize the coverage.
Women qualifying for Medicaid often have a monthly premium cost of zero. Each state administers this federal government program and decides eligibility criteria. Outcomes vary widely.
The Affordable Care Act provided incentives to states to expand eligibility to households earning up to 100% of the federal poverty level. Many expanded eligibility, while others did not, leaving a donut hole for women earning too much to qualify for Medicaid, but not enough to take advantage of the subsidies noted above.
Average Maternity Insurance Costs
Now that you have a sense of the many factors affecting your monthly premiums, consider average maternity insurance cost figures to help select the most affordable option that best fits your needs.
Keep in mind that your premiums represent only a fraction of what you may spend to carry a pregnancy to term, and deliver a baby. Prenatal care is extremely important, but most of your healthcare utilization occurs during labor and delivery, and sometimes after if your infant has a serious illness and requires confinement to a Neonatal Intensive Care Unit (NICU).
Compare your premiums to the example expenditure with and without insurance. It is easy to make the case to purchase a plan if you can.
The average maternity care cost without insurance should not be the deciding factor in whether your purchase a policy or not. While the majority of women will enjoy a normal labor and delivery, a significant portion will experience complications, and/or premature delivery.
Most families cannot afford the pay the average fee for a complicated delivery, or even an infant’s typical stay in a NICU without a healthcare company picking up most of the tab.
|Normal Vaginal Delivery||$12,000|
|Normal C-Section Birth||$17,000|
|Typical NICU Stay||$42,000|
Compare the projected premiums to these examples of average spending figures. Twelve percent of babies deliver preterm. You do not have to take these chances.
Purchasing healthcare when already pregnant is a complex topic. Obtaining a policy is worth the investment of your time and money – if you have the opportunity.
Having a third party pay most of these expenses is ideal. Consider the examples above compared to the average cost of maternity care with insurance. Of course, the plan design you choose may affect these numbers, so make the appropriate adjustments.
Every health care plan will have different deductibles, copayments, and coinsurance. However, one feature remains constant and makes our analysis easy, the maximum annual out-of-pocket expenses. We simply consider the worst-case scenario and assume you hit the annual maximum.
- $6,600 for an individual
- $13,200 for a family
|Normal Vaginal Delivery||$6,600|
|Normal C-Section Birth||$6,600|
|Typical NICU Stay||$6,600|
Now compare the two sets of average cost figures to see what you save by having coverage in force. For most families the choice is obvious. The savings are more than worth the monthly premium expense. Buy a policy, if the timing is right.