Under the Affordable Care Act, many preventive services -- including routine prenatal care -- must be covered at no cost to the patient: no deductible, no co-insurance, no co-payment.
"So the first thing they should be looking for and demanding is no cost-sharing for prenatal care," said Susan Berke Fogel, with the National Health Law Program. Common screenings like gestational diabetes and Rh incompatibility are just two of the tests included at no cost to the patient.
The only exception is if you have a "grandfathered" plan. This is a plan that predated the Affordable Care Act and has not been changed much since. These grandfathered plans are not subject to many of the Affordable Care Act mandates and may not include the same benefits.
... But There Is for Labor and Delivery
While your costs will depend on your plan, you will almost certainly pay something for labor and delivery. Consumers should contact their plan to try to estimate their costs and check other requirements.
"Understand specifics," says Lisa Zamosky, author of "Healthcare, Insurance and You: The Savvy Consumer's Guide." She also worked for a large managed-care organization before becoming a writer. "Are pre-authorizations required? Do you need to call the insurance company when you are admitted to the hospital?"
The good news is that you have time to sort this all out. Both Zamosky and Fogel stressed to make sure both your doctor and the hospital are in network. Some women prefer to deliver at a birth center, but you need to make sure the center is in network, too. If not, do the math to see how an out-of-network birth center pencils out compared with an in-network hospital. (My PriceCheck colleague Rebecca Plevin at KPCC looked closely at this issue.)
Even if you are at an in-network facility, it doesn't mean all the providers are also in network. I know this from my own experience. When I delivered my daughter in 2001 at an in-network hospital, I got a $1,200 bill months later for the anesthesiologist. (It was ultimately paid by my insurer.)
These "surprise bills" are not uncommon. A Consumers Union survey earlier this year found almost one in four Californians who had gone to a hospital or ER got an out-of-network bill from a doctor they had thought was in network.
There are steps you can take before you get to the hospital to try to avoid this, Zamosky says, "but you should know there is a risk."
She recommends having a pointed conversation with your obstetrician. "I would be forceful about it and be clear," Zamosky says. Tell the doctor: "'Don't bring anyone in the room who is not participating [in the network]' so that you're not surprised by bills."
But she also adds that "you don't have total control."
It's easy to imagine that you might need an anesthesiologist, but the only one available is out of network. A bill making its way through the California legislature, AB533, would end surprise bills by prohibiting consumers from paying out-of-network rates to doctors (or other providers) as long as they receive care at an in-network facility. If approved, the law would take effect in January.
What if You're Uninsured?
If you're pregnant, uninsured and outside the annual sign-up period for health insurance, you are out of luck for signing up for private insurance, including on Covered California. But you may be eligible for Medi-Cal, the state's version of Medicaid, which is open for sign up year-round.
Pregnant women can qualify for Medi-Cal at higher incomes than if they were not pregnant. "They shouldn't assume they're over income without filing an application," says Fogel. Medi-Cal providers may also be able to see a pregnant woman while she is waiting for her application to be processed under a program called Presumptive Eligibility.
Once your baby is born, there's still more to think about, insurance-wise:
- Contraception: Many women choose to have an IUD inserted after they have delivered their baby, but are still in the hospital. Under the Affordable Care Act, contraception -- including the IUD, which can be expensive -- is covered at no cost-sharing for the patient.
- Catholic Hospitals: If you are considering an IUD, be sure to talk to your doctor about it in advance. Fogle noted a big "consumer beware" by pointing out that Catholic hospitals may not provide them. If you are considering a Catholic hospital, she says, be sure to ask your doctor if that hospital will provide the full range of reproductive services.
- Breastfeeding: Counseling for breastfeeding and coverage of a breast pump must also be covered at no cost under the Affordable Care Act. But, especially with the pump, plans may vary in coverage. You may need a specific pump or you may need to purchase from a specific provider to get the no-cost benefit.
Of course, your baby will need health insurance, too, and you have a limited time to enroll the newborn. If you have employer-based coverage, you have 30 days to add the baby. If the mother of the baby has a spouse, the spouse also has the opportunity to enroll in coverage within 30 days, says Cheryl Parcham at FamiliesUSA.
If you have a plan through Covered California (or any marketplace plan), you have 60 days to sign up the baby. The additional bonus is that the whole family can pick a new Covered California plan, if you want to.
PriceCheck: Share What You Paid
Now that you have all these tips, we'd appreciate your help! While prices charged vary dramatically, it's impossible to know the variety of what insurers and consumers actually pay. That's because the "insured prices" are sealed by contract.
You can help shine a light on true costs by getting your explanation of benefits and heading over to PriceCheck. There you can anonymously share the price charged, what your insurer paid and what you paid, in co-pay or deductible.
