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Having a Baby Next Year? Choosing the Right Health Plan is More Important Now Than Ever

Congratulations on your pregnancy and welcome to one of the most challenging times for your body.

Your abdomen will stretch to the size of a watermelon, you’ll put on 20-40 pounds of additional weight, and your organs will be working in overdrive to protect the little one growing inside. You’ll need frequent doctor’s visits + ultrasounds + lab tests + hospital admission for delivery, so choosing the right health plan could mean access to better care & more coverage.

Health-ing for Two

This is the year where you should consider paying a higher premium for more generous coverage. You’ll be using more healthcare services, but your little one might also need to. It’s hard for doctors to predict if babies will be born with any health issues. Up until birth, the docs have been tracking mom’s health to evaluate the baby, but there is little known about the baby until it’s breathing independently.

I was fortunate to have two smooth and uneventful pregnancies, but then:

• NICU – my first was born with a tiny hole in his heart and had to be admitted into the neonatal intensive care unit for 8 days. The hole closed up on its own and hasn’t been a problem since, but the medical bills of $20K per day continued to worry us.
• Congenital Condition – my second was born with a rare condition that required MRIs, ultrasounds, and frequent visits to the children’s hospital.

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Both of my kids are healthy and doing great now, but I tell my personal story to emphasize the unpredictability (and therefore higher level of risk) of childbirth.

Pro Tip: More Risk = More Coverage Needed

So how do I choose the right health plan?

If you’re pregnant and having a baby, then these are the 3 specific steps to take when shopping for health insurance:

• In-Network Obstetrician (OBGYN) – start with your doctor and only look at plans where your doctor is in-network. This is the biggest cost driver because you’ll see the OBGYN the most.
• Quality of Care – every insurance carrier is rated for the medical care provided and one specific area is the care you’ll receive before and after birth. Check out the national & state rankings to check out the best carriers for having a baby.
• Hospital Fee – within the Summary of Benefits and Coverage, check out the “If you have a hospital stay” section (usually on the 3rd page).
  • Facility Fee - how much you need to pay for the stay – look for one that is capped at a flat rate (e.g. $3000 for a 3-day stay) so that you don’t have to worry about being nickel & dimed if your labor takes longer than expected
  • Physician/Surgeon Fees - how much you need to pay for the other doctors that will be helping you (e.g. anesthesiologist, pediatrician, etc.) and these are usually listed as a % coinsurance. Coinsurance is how much you are required to pay, so the lower the %, the better.

How to make sure you don’t get ripped off buying health insurance

Just like you would read the ratings & reviews of AirBnB hosts and Uber drivers to make sure you’re making a safe decision, you should check out the real-life member ratings & reviews of insurance carriers at TwoBeHonest.com.

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