Maternity expenses can be very expensive.  Simple deliveries can run $10K while C-sections usually start at around $20K.  If there are complications, costs can quickly escalate to 100's of thousands of dollars.  Maternity is probably the only health cost that you can plan for.  No one plans to break a leg but maternity can be planned or at least looked forward to. 

The California individual health insurance market has changed significantly over the last decade with the introduction of many plans that do not cover maternity at all.  For a young male or an older person in their 50's or 60's, this might not be an issue but for a female in her 20's or 30's, it can be an important consideration. 

Making health plan choices based on maternity needs

Individual and family health insurance is very different from Small Group (benefit provided by company) in that it is medically underwritten.  This means that we need to be in good health in order to qualify for coverage.  This also holds true for making changes.  Some people simply assume that they will switch plans when the get pregnant or before the need for maternity coverage arises.  If already pregnant, the health carriers in California will not approve a new application or a request to change to a plan that does cover maternity.  Some carriers such as Anthem Blue Cross and Blue Shield of California MAY allow downgrades from specific non-maternity plans to high deductible plans that do cover maternity.  We would not advise relying on this flexibility indefinitely.  It's better to plan ahead (perhaps years ahead) and choose a plan that covers maternity.  A good start is with the mid-priced, traditional PPO plans with Cross or Shield. 

Maternity is very expensive because the actual delivery occurs in a hospital.  Hospital or facility care is extremely expensive in California and the plan's max out of pocket or copay maximum becomes the critical issue.  The max out of pocket essentially lets you know at what point the carrier takes over for covered benefits (in-network).  Even if a plan requires you to pay more for office and prescription, a lower-priced plan with a lower max out of pocket can work out better for maternity coverage.  The HSA or Health Savings Account plans typically work well in this regard.

What about timing between pregnancy and a new or changed individual California health plan?

If you are looking at a new health insurance plan or considering changing health coverage prior to a future pregnancy, you want to make sure there is plenty of time between the effective date and the date of conception.  You want to make sure that there is no grey area between these two events.  You must be able to correctly answer the pregnancy question on the application.  The carrier can decline or defer coverage for other issues not relating to pregnancy so again, it's best to choose the right health plan up front.

What are your health insurance options if you are already pregnant?

If you do not have coverage or your plan does not cover maternity, what are your options in California for an individual health plan.  First, California group health insurance is guaranteed issue which means the carrier cannot decline coverage due to health (or pregnancy).  If you have a group option (directly or as a dependent), this is your first option.  Secondly, you can see if you qualify for AIM, an income-qualified health plan for pregnant women.  If this is not an option, you can check into MRMIP through the State as well. 

 

Other important concepts to help you understand your California health insurance quote are:

Individual health insurance underwriting
pregnancy and California health insurance
Small Group health insurance
AIM program
Understanding health insurance costs