If you are considering starting a family, one of the most important things you will need to consider is your health insurance.
When you decide to have a family, many excitements, concerns, and questions arise. When will it happen? How many kids do you want? Will you [or your partner] have a healthy pregnancy? What will the baby’s gender be? Do you want to wait or find out? What will you name them?
In addition to these exciting questions, you’ll also begin to have more practical questions, such as what your healthcare coverage for a future pregnancy, newborn, and family looks like. Exploring and understanding your health insurance options before you decide to start a family means you’ll know what to look for and how to make decisions come open enrollment time.
If you are considering beginning your journey towards starting a family and are wondering “What do I need to know about health insurance for my family,” you are in the right place.
Continue reading to learn more about health insurance for pregnancy, families, and more below.
Health Insurance for My Family Plan Costs
When starting a family, thinking about your financial situation is always prudent. Health insurance is a smart way for individuals and families to implement a financial safety net in the event of an accident or extreme sickness.
Health insurance is a contract between individuals or families and a health insurer. The insurer must pay part or all healthcare-associated costs in exchange for a premium. When looking at various insurance plans, it’s essential to look at related expenses to determine which plan is right for you:
- Premium — This is how much money you will pay each month for insurance
- Deductible — This is how much money you need to spend before the plan will start paying for your care. For example, if your deductible is $1,000, you will need to spend $1,000 on health care before your plan starts to pay. Premiums do not go towards your deductible.
- Co-Payment (AKA, Copay) — This is how much money you will pay for each health care visit or service, like an appointment with a specialist.
- Maximum Out-of-Pocket Expense or Cost — This is the highest amount you will need to pay each year for health care services. You will not pay more than this amount, even if the services you require cost more.
Health Insurance and Pre-Pregnancy
It is never too early to start thinking and preparing for pregnancy. Making an effort on your preconception health can increase your chances of having a healthy and easier pregnancy and a healthy baby.
Getting their bodies ready for pregnancy takes a couple of months for some. For others, it could take longer. Whether this is your first, second, or tenth pregnancy, preparing your body for the healthiest pregnancy possible is essential.
Utilizing your health insurance well before you or your partner becomes pregnant is one of the smartest things you can do. Your primary care doctor can help you make a plan, get any medical conditions under control, improve lifestyle and social behavior habits, manage medications, reach and maintain a healthy weight, prepare mentally, and more.
Covered Health Care Services During Pregnancy and Postpartum
The ACA requires all insurance plans on the Health Insurance Marketplace (also referred to as Marketplace) and Medicaid to cover various services for pregnant women, such as:
- No co-pay for all prenatal care visits. Prenatal care is the medical care you get during your pregnancy. No copay means expecting mothers will not have to pay their OB-GYN or midwife each time they go in for a prenatal checkup. Generally speaking, most pregnant women follow a schedule similar to this:
- Weeks 4 to 28: Check up once a month.
- Weeks 28 to 36: Check up twice monthly.
- Weeks 36 to birth: Check up once per week.
- Labor and birth services
- Birth control
- There is no associated copay for breastfeeding help or services. This includes appointments with a lactation consultant, breast pumps, and other breastfeeding-related equipment.
Starting a family means you must consider the medical needs you, your partner, and your family may have. When selecting an insurance plan, ensure that your required care is covered.
Health Insurance for Pregnancy
If you are ready to start your family and are trying to get pregnant, now is the right time to take a long look at your relationship with your current obstetrician and gynecologist (OBGYN). Health insurance for pregnancy and beyond is crucial. After all, this doctor will offer care throughout the entire 40+ weeks of your pregnancy and delivering your baby.
If you are looking for a new OB-GYN or midwife, it’s helpful to talk to your friends and family to get their recommendations. You can also contact other moms on parenthood- or pregnancy-focused Facebook groups or forums. Lastly, you can look at doctor review websites to help decide.
If you’re shopping for health insurance or if you are trying to decide which plan to go with, compare your list of potential physicians with your list of possible plans. It’s a good financial decision to go with an in-network doctor; you’ll end up saving money on pregnancy care, delivery, maternity care, and newborn care.
If you already have insurance, most insurance providers have search features on their website to help you find a doctor that’s in-network and look at patient reviews and ratings. Parents can use this same process down the road when searching for a pediatrician.
Health Insurance, Hospitals, and Birthing Centers
Once you’ve chosen your physician or midwife, you’ll need to become familiar with which facilities they practice at and have admitting privileges. Without those set privileges, hospitals and birthing centers can deny a provider’s requirements to treat you there. You can easily learn this information by asking their office or looking on the practice’s website for hospital locations and affiliations.
You can also use your insurance provider’s website to view which hospitals are in and out of your network for your specific plan. Most websites will allow you to search for in-network facilities, hospitals, birthing centers, and locations that have earned special honors for breastfeeding support, baby safety, and more.
In some cases, you’ll be fortunate enough to have more than one in-network choice nearby. If this is the case, you must determine which location you prefer. For that reason, many hospitals and birthing centers offer online or in-person tours of their maternity ward.
During the tour, ask yourself the following questions to help make your decision:
- Is the facility safe? Secure? Clean?
- Are the rooms spacious?
- Do I have to share a room with another new mom?
- Will I have a private room? Does insurance cover this cost?
- Are you allowed to have guests?
- Can a guest sleepover in the same room?
- Does your newborn stay in the room with you, or will they be in a separate nursery?
Health Insurance and Infertility Treatments
The Affordable Care Act (ACA) was signed into law in March of 2010 and does not require health insurance to cover infertility treatments, such as IUIs and IVF. Some plans will offer coverage and pay for part or all of the costs of infertility treatments.
Depending on your state’s laws and your specific plan, coverage for infertility services and the treatments they include will vary. The best way to learn about infertility treatment services is to contact your insurance company.
Health Insurance and Maternity Coverage
Once you’ve determined your healthcare provider and facility are in-network with your insurance plan, you will want to learn more about which pregnancy, delivery, and postpartum-related services are covered.
Find out information about the basics, such as monthly, biweekly, and weekly visits, blood work tests, and more. You may also want to look into special offerings such as prenatal massages, acupuncture for morning sickness, etc. It’s also good to understand the costs of a “normal” vaginal delivery versus a c-section, what is covered (and what isn’t) if you decide to get an epidural, and more.
While it may seem far away, now is the time to look at breastfeeding-related benefits (if you plan to breastfeed). Look into coverage for breast pumps, lactation consultant services, and more.
Notifying Your Health Insurance of Your Pregnancy
There is no need to tell your health insurance company that you are pregnant immediately. But many expecting parents find it worth doing as soon as they feel ready because many insurance providers offer free resources to pregnant women that help them take care of themselves, their baby, and how to prepare for parenthood (more on that below!).
If you plan to have your baby covered by your insurance plan, then notifying your insurance of the birth of your baby is necessary. Most insurance plans will automatically cover newborns for the first month of their life. During these 31 days, you’ll need to officially add your newborn to your plan by contacting your benefits administrator.
Health Insurance and Potential Maternity Resources
Health insurance can often connect expecting or new parents with free, helpful resources. For example, some insurance providers have programs that provide information on everything from helping fathers during pregnancy prepare for a new baby to dental health during pregnancy.
There are a lot of great resources and programs that can be beneficial to expecting parents. These useful perks associated with prenatal and postpartum care are free with many insurance plans. They can be found by accessing your personal insurance account or by contacting your insurance provider.
Health Insurance and Breastfeeding Services
As mentioned, most health insurance plans offer some sort of breastfeeding service coverage, such as counseling, support, and equipment during pregnancy and into the fourth trimester and beyond, for as long as you decide to nurse. Those who choose to breastfeed should consider taking advantage of these benefits.
Most plans cover the cost of a breast pump, but plans will vary in the guidelines on the types of pumps they cover, whether you can get it before or after the birth, and other rules. Your covered pump may be a rental or a new machine you will get to keep.
You and your healthcare provider must determine which breastfeeding services are right for you during this time. In some cases, insurance plans follow the breastfeeding recommendations of your doctor, which means some plans may require your healthcare provider to pre-authorize services before your insurance covers them.
You can get more information about breastfeeding benefits and coverage by contacting your insurance provider and chatting with your doctor.
Child Health Care Benefits
Most Marketplace and Medicaid health insurance plans require various preventive health strives for children with no copay, even if you haven’t met your yearly deductible, such as:
- Immunizations
- Vision screenings
- Well-baby and well-child visits
- Obesity screenings and counseling
- Blood work
- Developmental and behavioral screenings
- Oral health risk assessments
- and more
Need Health Insurance? The Insurance Experts at Bear River Mutual Can Help!
If you’re considering starting a family, health insurance is an essential step in planning for your future, and the Bear River Mutual Insurance professionals are here for you.
Health insurance is crucial to starting a family, and not having it means risking your financial stability. That’s why our team of trusted and experienced professionals is here to help you and your family find the best policy that provides the necessary coverage to meet your specific needs.
We know that searching the web for “health insurance for my family” can feel intimidating. That’s why our team understands that many questions come from buying insurance, so we are here to help you throughout the process, answer any questions, and address your concerns.
You can find us in three convenient locations throughout the Wasatch Front to serve you better: Orem, Provo, and Salt Lake City. Contact us to get your quote today.
