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.”
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.
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.
By Amanda Seitz - Journal-News, Hamilton, Ohio (MCT)
©2013 the Journal-News (Hamilton, Ohio)
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