Joining an HMO for Maternity Coverage
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One way to get maternity coverage is by switching to an HMO insurance plan. With an HMO, the insurance company saves costs by requiring you to use their network of doctors and hospitals. For instance, Kaiser Permanente is an HMO that pays their doctors by a salary instead of how many patients they see. You will find that the premiums are competitive as well.
When you get approved to join an HMO that includes maternity coverage, the waiting period is usually much shorter. Kaiser Permanente allows you to get pregnant after 30 days.
However, just because you get accepted does not mean it will be free to have the baby. Depending on your plan, there may be copays, coinsurance, and deductibles to meet. Some plans can have pregnancy copays of $3,500 while others have none. In addition, if your whole family joins the HMO, the cost can be much higher than an individual. You may want to consider having the mother join by herself.
Scenario Plans:
1. Individual with $5,000 deductible and $0 copay would pay $5,000 for the pregnancy because they would have to meet the deductible first.
2. Family plan with $10,000 deductible and $0 copay would have to pay $10,000 before the insurance pays the bills.
3. Family plan with $5,000 deductible and $0 copay.
The first two scenarios would have similar premiums, but since you are sharing the deductible under the family plan you would pay more out of pocket under the family plan. If the husband got his own insurance elsewhere, the mother would only pay $5,000. Under the 3rd scenario to keep the deductible at $5,000, the premiums would be the highest of the 3 scenarios.
4. Individual plan $5,000 deductible and pregnancy copay.
In the 4th scenario, pregnancy is covered after paying a copay. An example would be $1,500 for prenatal and postnatal care and a $3,500 copay for labor and hospital stay. If the plan says "copay before deductible" then your costs would be covered if you have already met the deductible with other medical costs. If not, then you still pay the fees.
There is one major factor to consider when comparing a copay pregnancy plan to a non-copay plan. If you join a plan where the pregnancy is covered after the deductible is met and there is no copay, then the month your plan resets can have a big impact. If your plan's deductible resets while you are pregnant, then you will have to meet the deductible again before any bills are covered.
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