Health Insurance Blog

Blue Cross Blue Shield of Alabama has information about a great program on their website.  “Baby Yourself” is a unique prenatal wellness program which gives expectant mothers important information about infant care and health care during pregnancy.

On the BCBSAL website, it discusses the benefits of the program.  “Baby Yourself” offers all expectant mothers support and educational materials from a Blue Cross registered nurse.  The nurse is experienced in labor, delivery, and newborn care.  You will be assigned your own personal nurse who can be contacted with any questions or concerns.  Gifts and products are available to help support health habits as well as show the importance of understanding all the changes that come with being new parents. 

The program is available to all members and is free as part of their health insurance benefits through BCBSAL.  A video is available on their website entitled “Baby Yourself, A Prenatal Wellness Program” where you can learn more.  You can enroll either online or by telephone.  This is a great initiative by Blue Cross to help support often overwhelmed new mothers and their families.

According to a recent eHealthinsurance study, comprehensive maternity coverage was only available in 12% of the 3,500 individual health insurance plans surveyed.  Non-comprehensive maternity coverage was offered by an additional 9% of health plans surveyed.

The 3,500 health insurance plans were geograghically diverse, and represented 47 US states.

Women who are shopping for an individual health insurance plan should ask the insurer or agent the following questions to make sure they will be covered properly

• Is there an out-of-pocket maximum for maternity coverage?
• Are there waiting periods before maternity coverage kicks in?
• Am I covered out-of-network ?
• Is my obstetrician or hospital in-network?
• Is there a deductible or co-pay for prenatal, delivery and postpartum services?
• Does the policy pay for a home birth or birth center delivery?

John Dorchner reports in the Miami Herald that the state might consider a bill that would require gender equity in Florida health insurance premiums. Florida’s insurance consumer advocate Sean Shaw is looking to team up with a congressperson that would sponsor legislation that would ban the practice of gender rating. Women pay higher premiums than men, even when you exclude maternity coverage.

For example, a Blue Cross Blue Shield of Florida policy for a 30-year-old in Miami costs $246 for a man and $291 for a woman. Insurers claim that women use more health care services and are more likely to keep up with regular screenings; some believe that’s a perverse incentive to forgo preventative care.

However, due to that higher level of utilization, older women are in better health and have lower health insurance premiums than their male counterparts. Using the BCBSFL example above, a 60-year-old Miami woman pays a monthly premium of $593, while a man of the same age pays $644.

Women of child-bearing age (19 to 55 years old) pay more for health insurance than men, says Linda A. Firestone, Ph.D in the Sun-Sentinel. A typical woman’s policy includes maternity coverage, which accounts for the gender disparity in insurance rates. Since the majority of American adult women eventually have children, health insurance with maternity coverage makes sense for them–especially if there are pregnancy or birth complications.

Group health insurance plans (for example, those provided by employers) in Florida do not allow women to opt out of maternity coverage. If a woman does not plan to have children, she can choose to buy one of many individual health plans, which allow her to opt out of maternity coverage. In fact, many insurance providers (such as Humana), no longer offer maternity coverage in their plans. Insurance specialist Larry Wides says the cost savings from a group plan tend to cancel out the reduced premiums resulting from the elimination of maternity coverage.

A recent press release from HealthAmerica has announced that Advantra, the HealthAmerica Medicare Advantage plan, is ranked among the top 20 best Medicare and commercial health care plans in the 2008 “America’s Best Health Plans” list. Advantra was ranked #18 out of over 200 plans.

The survey was conducted by U.S. News & World Report and the National Committee for Quality Assurance. It consists of the Healthcare Effectiveness Data and Information Set (which provides standardized performance measures), as well as the Consumer Assessment of Healthcare Providers. The results are published in the November 17th issue of the magazine.

The HealthAmerica and Advantra plans scored above the national average on 15 measures of patient satisfaction and medical services (e.g. treatment of certain diseases, health care access, preventative care, and prenatal care covered by maternity coverage). The HealthAmerica health care plans also scored higher than the Pennsylvania state average on 12 of those measures.

(Photo credit: Waldo Jaquith under CC 2.0)

If you are a woman who is planning on starting a family in the near future, you should first make sure that you have maternity health coverage before you get pregnant.  If your health insurance is covered by employer sponsored coverage you are likely covered, however if you purchase individual health insurance on your own, you probably had to add maternity coverage as a rider.   If you haven’t already done so, make sure this coverage is added to your policy before you get pregnant.  Once you get pregnant it will be too late to add this coverage, and the cost of delivery can be very expensive without health coverage.

According to the March of Dimes, the average cost of having a baby (including maternity care, labor, delivery and postpartum care ) is about $8,000 for traditional delivery and $11,000 for a C-section.  If you have maternity coverage as part of your health plan your out of pocket costs will be more like $500.

The average pregnancy costs mentioned above assume there are no complications, if you deliver a baby prematurely and they need to be placed in intensive care for a period of time, or you experience other complications, the out-of-pocket costs can sky-rocket and it wouldn’t be out of the question to see medical bills exceed $100,000.

The moral of the story is, if you plan to get pregnant, make sure you have maternity coverage first.