More women to get access to maternity benefits under new health care law

New coverage standards will force insurers to provide more comprehensive care.
MCT Regional News
Dec 2, 2013

More mothers planning to welcome a baby into their family will have maternity insurance coverage once new rules of the Affordable Care Act start Jan. 1.

Medical experts say they’re bracing for insurers to pick up more costs associated with labor, delivery and care for mothers who give birth in America, which has become the costliest place to deliver a baby in the world.

For the first time next year, insurers will be required to provide basic maternity coverage under the new health care law. And, insurance agencies are prohibited from considering pregnancy a pre-existing condition so women won’t be denied coverage because they’re pregnant.

The new rules will most directly impact women who don’t already get health insurance through their employers and aren’t eligible for Medicaid, said Alina Salganicoff, the Director of Women’s Health Policy at the Kaiser Family Foundation.

“Plans in the individual market, in the past, most of them did not cover maternity care,” Salganicoff said. “In response to the fact that this particular insurance market fell short, maternity was included as part of the essential health benefits.”

Uncharted territory

But health officials are unclear on just how much the law, which doesn’t specify what maternity services must be covered under insurance, will directly impact the cost of pregnancy for women. The law requiring insurers to provide maternity coverage is broad and doesn’t specify what services they must foot the bill for.

New coverage standards will certainly force insurers to provide more comprehensive care, said Edmund Funai, the chief operating officer of The Ohio State University Wexner Medical Center. For example, certain preventive and pre-natal care, such as breast pump rentals and certain screening tests, will be paid for by insurance providers without cost-sharing for the mother, Funai said.

Hospitals typically charge an extra fee for any procedure, such as an epidural, that’s needed in addition to the child’s delivery. Funai said he would consider an epidural a basic maternity cost, likely covered under the insurance law. But, what insurers decide to include in their coverage will likely remain unclear until next year.

“Some of that will be tested once (the law) fully goes into effect,” Funai said. “Whether or not an epidural is a luxury item is a matter of debate.”

Funai added that expectant parents will still need to scrutinize if they should undergo some prenatal testing, ultrasounds and genetic testing, especially if they’re not deemed necessary by a doctor, might not be covered by insurance, despite the new law. Hospitals can charge thousands of dollars for each genetic test or extra screening and it’s unlikely most insurance providers will pick up those costs.

“We tend to use technology more heavily than in other countries,” Funai said. “If someone wants some form of testing, they’re probably going to be responsible. People have to ask themselves, if the indication is not there that I need the test, but I want it anyways, is it something that I need to pay?”

Many employers and insurance agencies have been offering up patients more high-deductible plans over the last few years, medical experts say. That means out-of-pocket maternity costs will be unavoidable, no matter the new rules of the Affordable Care Act, for families with high-deductible plans, Jana Mixon, the Director of Access and Scheduling Services for Kettering Network, said.

“It’s becoming less frequent that I find a patient with a low, $1,000 deductible,” Mixon said. “You could have one employer with benefit plans that covers everything from A to Z; another employer could cover everything from A to M.”

Salganicoff of Kaiser agrees.

“People should know, as they’re thinking about selecting plans, particularly in the health care exchange, the deductibles for hospitalizations will depend on your plan,” Salganicoff said. “If you have a high deductible, you’ll have to pay a lot of money.”

Unknown financial burden

Each pregnancy — and what it ends up costing — will remain a tricky expense to navigate for many expectant mothers under the new laws.

When Erin Eckert, 32, of Hamilton delivers delivers her baby in May, she’ll have to drive an hour to Cincinnati. Under her health insurance, which only covers expenses within the University of Cincinnati Health system, she had to drop her current doctor. Eckert and her husband, Matthew, are trying to decide if, because of the long drive, they should plan an induction or rush to the UC Medical Center once her baby is ready for delivery.

“Time is of the essence when you’re in labor,” Eckert said. “Driving from Hamilton to downtown Cincinnati, that’s a bit of concern but clearly we have to do that or else we won’t be covered.”

With an insurance company that won’t require her to meet a deductible before sharing the cost of delivery, however, Eckert knows she’s one of the luckier moms.

But the co-insurance Eckert will have to pay still has the soon-to-be new mother worried. Eckert tried to get an estimate from the hospital on what her final bill might look like but, like every hospital does, they warned her that each pregnancy is different and giving out an accurate price estimate is near impossible.

“It’s very stressful not knowing how much of a financial impact this will have,” Eckert said.

Hospitals in Butler County give online estimates that quote the cost of just delivery being anywhere between $4,000 to $10,000 with Mercy Health Fairfield Hospital listing the lowest price.

Those estimates don’t include the costs covered by insurance agencies or any of the additional drugs or supplies nearly every pregnancy requires. And someone like Eckert, who is considering a cesarean section delivery, could be charged at least $4,000 more for the surgical procedure.

“There are many variables that determine the cost of delivery, not least of which includes the type of delivery and care measures needed during and after the birth,” Wendy Parks, the Director for Marketing and Communications at Atrium Medical Center in Middletown, said in an email.

Many hospitals offer financial planners to help patients determine how to pay for the costs associated with any medical procedure.

Hospitals within the Kettering Network, including Fort Hamilton Hospital in Hamilton, began screening patients for their financial situation within the last five years.

“We try to glean information from patients who may need financial help,” Mixon said.

Medicaid expansion

Identifying low-income patients is particularly important for families who might qualify for federal financial assistance through Medicaid, Mixon said.

At least 40 percent of all births are paid for by Medicaid, which pays for more pregnancies than any other insurer in the U.S.

Ohio will expand Medicaid under the federal health care law, although currently fighting a lawsuit over the measure, which means pregnant women will be able to sign up for the program faster and obtain more postpartum care benefits.

The expansion will expedite the rate at which pregnant women and children get access to the Medicaid benefits they apply for, Mixon said. She added that the state is still working out the details on how that process will work.

In Ohio, a single parent making anything under $31,000 qualifies for Medicaid, which pays for maternity costs in full.

Typically, those women would receive postpartum maternity benefits up to 60 days following their pregnancy but under the expansion, they will get benefits for a longer period, Salganicoff said. Newborns currently get Medcaid coverage for one year.

“It makes sure the mom has access to Medicaid coverage so she can stay healthy, as well as her baby,” she said.

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By Amanda Seitz - Journal-News, Hamilton, Ohio (MCT)

©2013 the Journal-News (Hamilton, Ohio)

Visit the Journal-News (Hamilton, Ohio) at www.journal-news.com

Distributed by MCT Information Services

Comments

truckin

All women have ALWAYS had "health coverage".with or without insurance. Big play on words.. Plus from what i have heard ALL women from 18/26 thru 99 will have to pay for this mandatory coverage also..

Contango

Better benefits, improved service & quality, while increasing the number of insureds, for less money.

Yea right. Only in Pres. Obama's economic fantasyland.

Price,
Quality,
Service.

Pick two, because it's economically impossible to have all three.

Alfalfa

Too little, too late. My husband and I just had a baby this past July. We couldn't afford health insurance and apparently we made too much to qualify for Medicaid. So we just recently received a payment book for our baby. Who can say they have a payment book for their baby. She isn't a car or a house. One of the most stressful things is to not have insurance while being pregnant and following the birth of your baby. Cost us almost $13,000.

truckin

1st. i guess you should have done a bit better "planning". as far as couldn't afford??? probably more like you did not wish to participate in one offered. Have yet to know a company that doesn't have some form of insurance. minus migrant, seasonal. Heck McD's n Walmart have some sort of offering. Because if you made too much for medicare/gov assistance you must be above 27,000 combined and legal. Is that it? not legal.. More to your story?
But still PROVE my point Not everyone has insurance but everyone does have ACCESS to medical care.. so we don't really have a medical accessibility problem. Of course not till millions get dump on the plan who are not even documented. and practicing doctors get fed up and quit or refuse to give service to Obamer'cares. SO since you were offered a pyt plan all is good.. Pay for your child. You chose to have. I don't not see the point to your comment???
2nd my parents had some insurance back in the 60's yet still say they had to make pyts for about 2 yrs on me.. So it is not nothing new.. Just most bad planners such as you are really good planners and just don't work...

Contango

Re: "Cost us almost $13,000."

Not-to-worry; based on the projected outlays of govt. entitlement spending, that child could help fund you and your spouse's public health and welfare benefits (Medicare, Obamacare, Soc. Security, et. al).

For $13K, that child is potentially a great investment in your financial future!

Dr. Information

So what you are really saying is, you would have rather had a payment book for a car or house and not your child. You may want to rethink how you post things because clearly you value possessions more than life.

hit the road jack

Alfalfa: I'll bet I got one better than you:I got bills in the mail from human services and I'd bet my bill was for more than your payment book is and it didn't quit in 2 or 3 years like yours will! so you should feel good that you only have to pay $13,000.00 mine was many times that.

Alfalfa

I'm not trying to compete with anyone on who's situation is worse. It's not a contest. And no, I shouldn't feel good about the fact that my bill is $13000 just because yours is more. That would be like me telling you that you should feel good about your bill because I'm sure there is someone else out there who's pregnancy and delivery bill is bigger than yours. Sorry, that you had to pay such a large bill with not having any health insurance. I gather something went wrong with your pregnancy/delivery if you owe that much. I feel bad for your situation. But don't sit there and judge me and tell me that I should be content with mine. I was just voicing my opinion while at the same time paying my bills.

FTFOI

Ok. Just F.Y.I. Alfalfa. At no point in history was having a baby free. You have a choice and made it. You can plan for a child. Purchase health Insurance, pay for a year before coverage begins, Then carry the child, give birth, get a bill for what insurance did not cover. That has never changed. Second choice, Except the fact you have to pay for having a child. Third choice, Be irresponsible do not plan it, Get pregnant, quit working, and let everyone else pay for it. Either way you or somebody else pays for the child. Never has it been free.

Alfalfa

My god people. How dare you judge me the way you are. You don't even know me. My whole point is that it would've been nice for this law to be in effect while I was pregnant. Truckin, you act like you know everything about everything. At my job, yes I am employed and so is my husband, there was absolutely no insurance offered. We looked into private insurance and it was going to cost $1200 a month with a $5000 deductible. So add up the cost of deductible and paying the premium for about 9-10 months. That adds up quick. And Dr. Information, how dare you say I care about possessions more than my child. I was just saying it was crazy to have a payment book for a baby like you would for your house or car. Don't put words in my mouth. And never did I say I wanted a baby for free. I will pay for her, no problem. Like I am doing now. I don't need to quit my job pop out more kids and live off the government. We work damn hard for what we have and it just doesn't seem fair that we can't catch a break. That's it people. TAKE IT EASY!!

Dr. Information

Glad you and your husband are working and doing what so many others aren't. I never meant for my words to anger you, I was just saying, it came off wrong.

Babies are expensive. Avg. cost is nearly 20K nationwide.