Vanessa Villegas, 31, of Los Angeles, and her husband would like to start a family soon. She says she's interested in having the baby at a birthing center or at home with the help of a midwife. She asks Impatient: What type of health insurance plan would provide the best coverage for an out-of-hospital birth?
Villegas currently has a high-deductible health plan. Now that Covered California has begun its new open enrollment period, she wonders whether it would be wiser to keep this type of plan and use her Health Savings Account to pay for any birthing expenses not covered by insurance, or whether she should switch to a plan with a higher premium and lower deductible.
Before I answer her question, let's review a few facts:
- Under the Affordable Care Act, a lot of women's prenatal care should be fully covered by insurance. Preventive tests – like those for Hepatitis C or gestational diabetes – should be covered at no additional cost, but services for diagnosis or treatment may not be.
- Labor and delivery should also be covered by insurance. But as I reported during our #PriceCheck investigation into the cost of childbirth in Southern California, deductibles, co-pays and coinsurance could apply.
OK, back to Villegas' question: I reached out to Nicole Lee, founder of Natural Health Advocate, a company that helps women navigate the health insurance system when they're interested in giving birth outside of the hospital. She also does the billing for GraceFull, a birthing center in Silverlake that I featured in a previous post.
I asked Lee what advice she'd give to women like Villegas, who are interested in buying insurance that would accommodate their birthing preferences.
First of all, she says, here are a couple of things to keep in mind:
- In general, she says, women with PPO plans have an easier time getting a portion of their births covered than those with HMO plans.
- Even while you're shopping for a plan that accommodates out-of-hospital births, keep in mind that there's always a chance you'll need to be transported to a hospital, where you could be responsible for other costs.
Lee says the question of whether to select a plan with a higher premium or a higher deductible depends on individuals' financial budget and preferences. It's a tradeoff, she says: Would you rather pay more each month, regardless of whether you see a doctor? Or would you rather pay more out-of-pocket when you do need medical care?
These decisions are complicated by the fact that, at least in the greater Los Angeles area, most birthing centers and midwives are considered out-of-network care, Lee says.
Neither Lee nor I can recommend one specific plan or insurance company over another, but she says women like Villegas should research each health plan they're considering. Here are a few factors that Lee recommends considering:
- Check whether a plan includes – or explicitly excludes - coverage of midwifery services or birthing centers.
- Check the plan's out-of-network deductible. Is it higher than the cost of the out-of-hospital birth itself?
Lee offers two more options:
- If you go the high-deductible route, you can withdraw money tax-free from your Health Savings Accounts to pay for birthing center services, she says.
- You can try negotiating a cash price with the birthing center or midwife.
Do you have health insurance-related questions during open enrollment season? If you e-mail me at Impatient@scpr.org, I'll try to find you some answers!