Health Insurance Blog

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.

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.

There have been several articles published within the last week, most notably in the New York Times regarding health insurance rates paid by women compared to rates paid by men.  The article used health insurance quote data gathered from such health insurance companies as Humana, Aetna, and Wellpoint as well as online health insurance marketplace ehealthinsurance.com, and state high-risk pools.

The article in the New York Times sites several examples of price discrepancies between women and men of similar ages for identical coverage levels at various health insurance companies.  The data is rather compelling as the health insurance rate differences are in the 30-50% range.  However, does anyone really believe that health insurance companies are unfairly setting rates artificially high for women?

The article mentions the comparatively high health care expenses for women during child bearing years, but later dispels this as the sole explanation siting that the wide range in premiums couldn’t possibly be justified by actuarial analysis.

It would have been a more compelling analysis, and further solidified the argument if the author went on to compare health insurance rates for a 60 year old man vs women, an age when men’s health issues become more prominent.

After a quick analysis comparing rates on ehealthinsurance.com, an elderly man can expect to pay about 5% more than an elderly women for identical coverage levels.  The results of this quick test were not quite the results that I was looking for that would invalidate the argument that women are being gouged on their health insurance rates.  But my gut feeling tells me that the disparity between a women’s and men’s expected health care costs in their mid 30s, for example, are indeed magnitudes apart, and health insurance  companies are appropriately planning for potential claims.

The department of insurance (DOI) in each state must approve health insurance premiums based on claims history, and actuarial analysis, and would not approve rates if the this analysis didn’t support the rates  they requested.