Maternity Pregnancy Insurance Coverage Options in NC

There's not much information available online regarding strategies for planning to pay
for maternity, including delivery and prenatal care in North Carolina, so I've decided to
write this article to provide a little insight on the issue.

If you are currently pregnant, your options, in order of desirability, are Medicaid, group
insurance, and prepayment plans. After you are pregnant, it is not possible to
issue an individual policy. Application will automatically be declined. If you are
in the process of planning your pregnancy, the best options for minimizing your
maternity costs are Medicaid, group insurance, individual insurance, prepayment plans,
in order of descending desirability.

The average total maternity charges submitted to Blue Cross Blue Shield of North
Carolina in 2007 was $20,015 per pregnancy 1. A patient may be required to pay this
full amount, however many families negotiate with hospitals and providers to pay a
discounted rate when the only option is to pay out of pocket.

When planning to cover the costs of maternity the four primary options in North
Carolina are as follows:

1. Group maternity insurance coverage. This is often the most advantageous way
to pay for maternity costs because many group policies cover maternity for all females
on the policy without an additional rider. Also, if you are already pregnant, and don't
meet the income requirements for Medicaid, this is your best shot at getting your
pregnancy covered by an insurance company. Additionally, some group policies do
not consider pregnancy a preexisting condition, so this is a good option to consider if
you are already pregnant.

After the charges have been submitted to the insurance company, it is worthwhile to
ask the hospital if you can get a discount by paying the deductible in full as opposed to
making payments over time. I am aware of instances where the deductible has been
discounted for a prompt payment in full.

2. Individual maternity insurance coverage. At the date of this writing, I am only
aware of one individual health insurance company in North Carolina that offers
coverage for maternity. The company is Blue Cross Blue Shield and the policies are
Blue Advantage® and Blue Options HSA sm. I am not aware of any individual
health insurance policy that will cover you after you are already pregnant.
HumanaOne previously offered an individual maternity policy, but has since
discontinued it. I am generally skeptical of small health insurance companies, if you
are even able to find one that offers maternity, because they are often on tight budgets
and as a result their policies often contain ungainly loopholes.

The Blue Cross Blue Shield individual policy is somewhat similar to a prepayment plan
through a hospital, as the premiums for adding the maternity rider are fairly substantial.
However, the benefit of the policy is that, in the event of a pregnancy that involves
complications, your costs are much more predictable. Pregnancies with complications
are often significantly more expensive than a normal delivery, so this option is more
desirable than a straight prepayment plan.

BCBSNC's maternity plan uses the deductible and coinsurance of the plan it is
attached to, so it is important to evaluate the varying cost of maternity riders within the
context of the deductible and coinsurance of each plan. For example, suppose the
maternity rider for a plan was $350 per month. Suppose this plan has a $2,500
deductible with 100% coinsurance. Now the total cost for the pregnancy over the
course of a year is $350 times 12 months = $4,200 + the $2,500 deductible = $6,700
for the pregnancy. Now, suppose a second plan had a maternity rider for $450 per
month. Suppose this plan has a $1,500 deductible with 100% coinsurance. Now the
pregnancy would cost $450 times 12 months = $5,400 + the $1,500 deductible =
$6,900. With this hypothetical scenario, the first option is better even though the
deductible is higher. The purpose of this example is the illustrate the importance of
paying attention to how much it costs to lower your deductible.

With BCBSNC's maternity plan, it is also important to plan the timing of the pregnancy.
The individual deductible reset every January 1st, so it is best to start a maternity
policy at the beginning of the year and start trying to get pregnant at that point.
Otherwise, the pregnancy will overlap calender years and you may have to meet your
deductible more than once.

To learn more about the Blue Cross Blue Shield NC individual maternity policy follow
this link.

3. Medicaid maternity coverage. Follow this link for income eligibility requirements
and instructions for application of coverage.

4. Prepayment plans. I you are already pregnant, a prepayment plan is a last resort.
In this case, you should contact the prenatal and delivery caregivers to negotiate a
prepay rate. Many hospitals offer discounts for paying out of pocket in advance.
When conducting prepayment negotiations it is important to be very specific about what
is covered by the arrangement and if the price includes complications of pregnancy, or
only normal delivery.

Summary
Overall, from a financial perspective, Medicaid is typically the least expensive option,
followed by group insurance. Individual maternity is the third most desirable as a
measure to minimize the cost of unexpected complications of pregnancy. The fourth
option is the prepayment plan negotiated directly with the provider.

1. Average charges submitted to BCBSNC for maternity services, professional and hospital etc. in 2007. Your charges
may vary.

Maternity / Pregnancy Insurance Options in North Carolina

Goebelt

Insurance
Services, Inc.

Where Integrity Matters

Authorized Agency

Rate Quotes (under 65)

Blue Advantage®, Blue Advantage
Saver sm, and Blue Options HSA sm

Compare Blue Advantage®
Plans A, B, and C

Apply Online

Goebelt Insurance Services, Inc. and David Goebelt are an independent authorized agency/producer licensed to sell and promote products
from Blue Cross and Blue Shield of North Carolina (BCBSNC). The content contained in this site is maintained by Goebelt Insurance Services,
Inc. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

David Goebelt
Authorized NC Agent
800-918-1158

Rate Quotes
(Medicare Beneficiaries)

Blue Cross Blue Shield of North Carolina Health Insurance Quotes