Having a baby? First of all, congrats! We hope and pray for a smooth pregnancy and arrival for your new baby. Before baby comes, let’s get your ducks in a row regarding your health insurance so you can be ready to take on the world—and those dreaded medical bills.
Take a deep breath. You've got this, mom!
Choosing a health plan when you're having a baby is actually pretty easy. Here’s what you need to know about your health plan so once baby comes you can focus on all of those special moments and sleepless nights instead of spending time and brain power deciphering medical bills.
- Make sure your OBGYN and hospital you're delivering at are "in-network". You can use our doctor search tool to do this, or in this case, it's also worth calling and talking with your doctor's office.
- Find a plan that minimizes the following equation: Cost of baby = monthly premiums x 12 + max-out-of-pocket limit
Understanding your max-out-of-pocket
The max-out-of-pocket limit is the most you'll pay in a given year before you pay no more for covered services. For most plans in your area, it probably ranges between $3,000 to $7,000 for each individual. For example, if your plan's max-out-of-pocket limit is $5,000 and you get a $100,000 bill, you pay $5,000 and not a penny more as long as the charge was for a covered service (having babies are covered) and the provider was in-network (back to step 1 above).
You will almost certainly reach your max limit when you have a baby: The full cost for having a baby in the US ranges between $20,000 to $60,000 for regular deliveries and $40,000 to $100,000 for c-section deliveries. Your prenatal care will cost $2,000 to $6,000. This only goes up if there are any complications or additional treatments needed.
The mistake many people make is they forget about the Premium component of the equation above. They assume they will need a Gold or Platinum plan when they are having a baby because those plans will cover more costs up front. This is true, but you may still end up paying more in the long-run. Depending on the plans in your area, a Bronze plan may actually be better. You just have to see.
Here's an example:
|Plan Metal Level||Average Monthly Premium||Average Max-Out-Of-Pocket|
|Typical Bronze Plan||$250||$6,000|
|Typical Gold Plan||$600||$3,000|
The numbers above are typical and will vary in your area, but let's play this out:
For the Bronze plan: Cost of baby = $250 x 12 + $6,000 = $9,000
For the Gold plan: Cost of baby = $600 x 12 + $3,000 = $10,200
Take Command Health is here to help
You've probably noticed by now that having a baby is going to be expensive. That's just the reality when you're on insurance in the individual market and don't have a company helping you pay—of course its still better than having a baby without insurance, which would come with a pretty scary price tag. The good news is that you can save thousands by making smart decisions ahead of time.
On our survey, you can tell us you're expecting a baby by typing "have a baby" or "pregnant" on the condition search and we'll run the numbers above for you with the plans in your area.
You have a right to negotiate your medical bills. Especially since up to 90% of them contain errors.
Billing mistakes happen, and unfortunately they happen with great frequency. There are several ways you can take control of your medical bills and potentially save hundreds or even thousands! We imagine that in the weeks after giving birth, the last thing you want to do is call the medical billing department (probably several times) and wait on hold to ask for a discount or to fix billing errors. Good news, mamas! As part of the Take Command Health Premier Plan, we offer a free medical bill negotiation service that will analyze your bills and negotiate on your behalf, saving on average 40%! Read more here on how bill negotiation works.
More tips from the pros
- The baby is covered under the mother's insurance for the first 15 to 30 days of his or her life, depending on the state you're in. Make sure once your baby comes, you call your insurance company to add him or her within 15 to 30 days!
- Don't get wrapped up in "family" deductible and out-of-pocket-max amounts. The baby counts as the mother, so you'll just be liable for the mother's deductible and max-out-of-pocket.
- For the mom's prenatal care and delivery, some doctors and hospitals will charge one lump sum and others will charge by doctor visit. It usually doesn't make a big difference cost-wise unless your pregnancy crosses over a calendar year—which could technically make you liable for 2 deductibles and max-out-of-pocket limits (please, try not to have your baby on New Year's Eve!)
- A month before you deliver, you can request your breast pump (if you plan on breastfeeding) and in most cases, this will be covered by insurance. Here is a recent blog with a few expert tips on how to navigate the system!
- Once baby arrives, amidst the frequent pediatrician visits, don’t forget to take care of you! This blog explains the four doctor’s appointments every new mom needs after baby.
Why Take Command Health?
Take Command Health believes in transparency and empowerment in this confusing realm of health insurance. Our mission? To arm you with the information you need to make smart decisions and avoid wasting money on the wrong plan.