Information on Pregnancy and Maternity

Information on Pregnancy and Maternity in the US for US or Non US Citizens

Summary - This information is for both US and non US citizens. If you are pregnant or planning to have a child in the US then it is important to understand how the pre-natal care, birth and healthcare for the Mother and child can be handled. If you are not covered with health insurance that covers pregnancy, have health insurance at all or can be covered by a government program such as Medicaid or a state high risk pool that covers pregnancy then we can help by significantly reducing your cost. Please read the information below and ask any questions you like.

Handling Pregnancy and Maternity in the US

Congratulations on your decision to have a baby. It is important that you are able to receive pre-natal healthcare and not be stressed about the costs of the birth. A normal no issues birth costs about $6000 not including pre-natal care. Complications such as a cesarean or premature will make the cost very much higher. Hopefully that does not happen but it can and that does not have to be a stressful issue.

The best way to take care of this is to be on a US employer sponsored health insurance plan. All US employer group health insurance plans cover maternity. Maternity benefits are not subject to any waiting period or pre-existing condition exclusions even if the person is already pregnant when she enrolls.

It is not necessary for both parents to be on an employer health insurance plan. If the wife is working where the employees are offered the employer group health insurance, then she should be enrolled on the insurance. If she is not enrolled then she should enroll during the open enrollment period for the insurance. You need to find out when that is and be sure to enroll. You only need to enroll yourself.

If the wife is not employed, her employer does not offer health insurance or she is not eligible for the employer group health insurance then she needs to check if the husband’s employer offers group health insurance. This will be more expensive as the husband and the wife will have to be on the insurance. The husband would be on as the employee and the wife as the spouse.

Medicaid is an option for pregnant women that are US citizens or permanent residents. Qualifying for Medicaid is based on family income. For a pregnant woman the household income must be less than 185% of the Federal Poverty Level. A pregnant woman is counted as two persons when checking eligibility. For example if the woman is married than with no other children than the qualifying level would be based on the Federal Poverty Level for a three person family.

Maternity coverage is in general not offered on US domestic individual health insurance plans or the benefits are limited. Once you are pregnant then there are no individual health insurance plans available. States have high risk pools but those plans may or may not cover maternity or pregnancy. If you are a Florida resident as a US citizen of otherwise legally in the US then I may be able to help you with the Florida High Risk Pool plans. You can find out some more about that by clicking on Florida High Risk Pool Plans

Permanent international health insurance plans often include maternity benefits. International health insurance is available to US citizens that live, work, study or are otherwise outside of the US more than 6 months of the year. International health insurance plans are available to non-US citizens worldwide including the US as long as they do not qualify for domestic US health insurance plans. Permanent international health insurance can be worldwide coverage and include the US. The maternity benefits of these plans start after the plan has been in effect for 12 months. Plans are not approved if applied for while the person is pregnant. Underwriting is similar to US domestic individual health insurance plans. It is important to plan ahead as after a person is pregnant it is too late.

If you are considering having a family or having more children, then now is the time to make sure your pregnancy and the birth will be a happy family experience. For you to know that you can focus on the health of the mother and the child and not have financial issues creating stress takes planning and taking action in advance.

Maternity on Individual Plans

Maternity benefits on individual health insurance varies, by insurance company and by plan. No individual plan offers maternity benefits in the same way as group health insurance does. Most companies do not offer maternity at all on individual plans. All insurance companies will decline to offer individual health insurance to someone that is currently pregnant and in general will decline her husband and children as well until after the baby is born.

If a plan offers maternity benefits, it generally will have some or all of these features:

There is a waiting period before a person would be eligible for benefits from the maternity benefit but could become pregnant during that waiting period. For example, no benefits are paid during the first 12 months the insured is on the policy and has the maternity benefit, then plan starts paying benefits.
Another option is conception must have occurred after a set amount of time the person has had the maternity benefit, 270 days is a common time period. You must have been insured and had the maternity benefit at least 270 days before you became pregnant. Any pregnancy prior to that time would not be covered.
The benefit is stepped over a period of time. There might be some small benefit payable if the insured becomes pregnant in the first year, a larger benefit payable if the insured becomes pregnant in the second year, larger in the third year and so forth.
A flat amount is paid for maternity such as $1000 after a $500 maternity deductible. No more is paid no matter what the cost of the pregnancy.
Maternity is paid as a separate benefit with its own deductible and coinsurance amount, but without a benefit limit.

Please be aware that your information including contact numbers or email addresses and all personal information is kept absolutely confidential and complies with the HIPAA privacy act.