Paying for Pregnancy and Birth Without Health Insurance
Babies, whether planned or not, generally come into the world with wonder, delight, and a very high hospital bill. While it used to be that moms relied on their employer's health insurance (or that of their spouse's) to see them through with the expenses, the healthcare landscape is changing fast; no longer can you be guaranteed that baby will arrive while you're covered. (See also: Can You Afford to Have a Baby?)
Before you worry that a sudden change in employment, a venture into entrepreneurship, or a sneaky health insurance clause will have you seeing big bills, check out this list of options for moms-to-be on a budget.
Presumptive Eligibility and Medicaid
While most doctors will ask to see your insurance card, many will not deny seeing you for prenatal care, especially if you are upfront and honest about your situation. If your doctor is a Medicaid provider, they can assist you in filling out the necessary forms to apply for assistance. Even if you don't qualify for traditional Medicaid coverage due to a higher income, many pregnant moms qualify for prenatal and post-delivery care via special state and federal programs aimed at ensuring babies are born healthy.
"Presumptive eligibility" simply means that the provider chooses to provide you care even before you have completely filled out your application for assistance. They go off of the information you give them, as well as a positive pregnancy test. Once you've applied for, and been accepted to receive, health benefits, you can usually expect to see no interruption in your care routine. Most Medicaid programs will also pay bills related to your pregnancy for up to 90 days prior to your application. Keep your receipts.
Many hospitals and health systems have non-profit funds that they give to lower-income patients who do not have adequate insurance and don't qualify for state or federal assistance. Usually, these funds are distributed on a sliding scale, but they can significantly cut down on your final bill and keep you from falling into medical bankruptcy or other scary situations. You should ask about any non-profit funds that may be available at the first visit when speaking with the financial counselor at your physician's office or health center.
Preexisting Coverage Plans
These plans are also administered through the government and act as bridge coverage for pregnant women until new coverage laws go into effect. To qualify, you must not have had coverage in the last six months, however. (It's important that, even while you are waiting to qualify, you don't skip doctor's appointments!)
For moms who don't qualify for assistance or choose not to apply for it, there are discounted plans available for moms who can settle their bill prior to delivery. While there can be some surprises with any pregnancy (emergency c-sections, for example), most physicians have a standard schedule of care that they recommend, along with pricing tiers for the prenatal visits, tests, and final delivery. For moms who can pay a little at each visit, or even in full prior to be admitting to the hospital, there is usually a hefty discount — 25% or more in many cases.
No mom wants to skip out on essential services that can detect problems and provide a happier outcome for mom and baby, however, not all moms agree on what diagnostics are necessary.
Many moms have chosen to opt out of extra screenings, ultrasounds, or blood tests that are more informative than preventative (genetic screenings, for example). This is a very personal decision that should be made with the full understanding of what you are giving up, but it can prevent you from being charged thousands of dollars for screenings that you didn't want or need, anyway. Just be sure to discuss all extra tests with your doctor before the visit they are scheduled for. Many nurses follow a standard procedure for care and may assume you want the tests. If you are opting out of any diagnostics, ask what samples will be used for and ask to sign off on any lab work that you feel may be out of your comfort zone.
This increasingly popular form of prenatal care is gaining respect in the health community, especially among those with limited health coverage. While the cost can vary wildly between geographic areas, most midwives that come to your home for health care can save you 50% or more on the cost of your prenatal care. Add to that the discount received by delivering at home or in a birthing center (rather than a traditional hospital), and many happy moms have reported total bills of no more than $3-4,000 (compared to the $5-12,000 of a doctor-assisted birth).
This choice will be more suitable for those who prefer a natural birth and live close to a hospital (in case of a life-threatening emergency), but many moms have enjoyed the perks of using a midwife while paying for the services in full at the delivery.
Health Care Is Changing
Health insurance is changing all the time, especially in light of the recently passed health care legislation. Regardless of any upcoming developments, however, there are a couple of things you can do before you get pregnant to ensure that you aren't scrambling for coverage at the last minute.
Don't Assume That Your Health Insurance Covers Maternity
Many self-employed and individual plans do not cover maternity care, and those that do may require a separate rider to be purchased. Additionally, those that cover maternity care may only pay for services that are considered "emergency" and will not cover basic prenatal care and standard delivery fees.
Don't Delay the Paperwork
If you plan on becoming pregnant and are eligible for open enrollment at your work, check and double-check that everything gets filled out and turned in on time. Likewise, many employer plans require that you enroll the newborn on the company plan within 30 days of birth, or the child will not receive coverage (and your prenatal and delivery claims may be denied.) Be diligent and never assume that your work has "taken care of it."
How did you pay (or are you planning to pay) for pregnancy related health care costs?