Planning to Have a Baby under ACA/Obamacare? – Insurance & Cost Considerations

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California Residents:

Planning to have a baby in the near future? Are you currently insured under the Affordable Care Act? Below is the out of pocket costs for having a baby under each plan for California.

Total Pregnancy Out of Pocket Costs

No insurance $12,410
Bronze $6,800
Silver $4,383
Gold $2,383
Platinum $1,191

Based on quotes from 2017.

Overall Considerations

  1. Vaginal birth makes up the bulk of the cost, with others including ultrasound and basic lab tests.
  2. Cesarean birth will cost more than vaginal birth.
    • For example, vaginal birth in Northern CA in 2019 costs $11,466 compared to a cesarean section at $15,660.
  3. Complications may contribute to additional out-of-pocket costs.
  4. Price will vary with your location.
  5. Your current doctor may not be covered under certain plans.
  6. HMO vs. PPO: there are few low-cost PPO options, and many Ob/GYNs are in only 1 or 2 PPO networks; none of the HMO networks.
  7. During the prenatal period, you will primarily have multiple office visits. Each doctor visit will require some lab tests. In Bronze, Silver, Gold, and Platinum coverage, these are covered as preventive care and will not make a difference which plans you choose.
    • Silver may be your best choice during the prenatal period.
  8. During the delivery period, ideally, the best plan to choose involves no deductible and a fixed co-payment for hospital costs.
    • Platinum may be your best choice during the delivery period.
  9. Once your baby is born, that creates a Special Enrollment Period.
    • Within 60 days, you can switch from the higher cost delivery plan to a lower-cost plan.

Insurance Plan Considerations

  • Affordable monthly premium

Ideally have:

  1. Copay: Unlimited doctor office visits
  2. Deductible: low or none
  3. Out of pocket maximum: small
  4. Copay for hospital stays: fixed
  5. Copay for labs and imaging: fixed

References:

coveredca.com
spfinsurance.com