1. Are maternity
benefits covered? Private health insurance plans don't automatically
cover maternity benefits -- they are often "riders" on the main
policy. eHealth's 2008 report, The Cost And Benefits Of Individual
And Family Health Insurance Plans, showed that nearly half of all
policy holders were women (46.3%) and one-quarter (24.2%) of all
policy holders had maternity coverage. Maternity coverage is a
mandated benefit in some states, but not all of them. If you don't
need maternity coverage (for those not planning to get pregnant) you
can save money buying coverage that doesn't include it.
Note: If you don't have maternity coverage, any
claims related to prenatal care, delivery and postnatal services are
not covered benefits. If you're planning to have children, or if
there's even a chance you might get pregnant, your plan should
include maternity benefits that cover you from preconception through
postpartum.
2. What do I do if I can't find a plan that offers
maternity coverage? In some states, you may not be able to find
plans that offer maternity coverage. If you can't find maternity
coverage in your area, connect with a licensed agent in eHealth's
call center, or reach out to the Foundation for Health Coverage
Education at www.coverageforall.org where you can find public
programs in your state that may help you get the maternity care you
need. You should also contact the Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC), which may be able to
provide you with additional assistance. Note: Some health insurance
plans offer maternity benefits as a "rider" but, in many cases, a
maternity rider won't cover a considerable portion of your costs for
a hospital delivery or alternative delivery options such as
delivering from home. Speak to your doctor about your delivery
choices. If you purchase any supplemental maternity coverage, be
sure it covers the delivery option you've selected. It's also a good
idea to go to an obstetrician and see if they're willing to
pre-negotiate a rate with you.
3. How much preventative care is covered?
Preventive care is especially important for women, and individual
plans offer a range of options for doctor visits, lab/x-ray and
other services. Routine mammograms and pap tests are two of the most
important tests to help detect diseases early on. The type of plan
you select is ultimately a personal choice, but if you want to see
your personal physician and OB/GYN every year then you should look
into plans with a co-pay option for preventive care visits. Co-pays
typically range from $20 to $35 per visit. Note: The vast majority
of individual plans include preventive care coverage, but you may be
able to save money on premiums by selecting a plan without them. If
you're shopping for insurance at
eHealthInsurance.com
be sure to review a plan's preventive care
benefits by selecting the "Preventive Care Coverage" section of a
plan summary.
4. Can I keep my doctor and the specialists I
like? If you're happy with your current doctor you need to make sure
he or she is in the network of the insurance carrier you choose.
That will allow you to continue to see your doctor. You want to
avoid paying out-of-network rates if at all possible.
Note: Many HMOs and some PPOs require a referral
from a primary care physician in order to see an OB/GYN. If you
visit your OB/GYN frequently, you may prefer a plan without this
requirement. If you're shopping at
eHealthInsurance.com be sure to use our "Doctor Finder" feature,
which allows you to key in your physician's name and view the plans
that include him or her in their network.
5. What are my best options if I need prescription
drug coverage? You may be able to find low-cost prescription drug
programs at certain retailers, or other locations in your area.
These plans typically cover the costs of generic drugs. In the
individual health insurance market you'll typically have the option
to buy a health insurance policy that includes prescription drug
coverage, or select a policy that does not. If you find a low-cost
prescription drug program then you may be able to save money by
selecting a health insurance plan that does not cover prescription
drugs.
Note: If you elect to purchase a low-cost
prescription plan through a retailer, you won't always have access
to the newest and most advanced drugs available. If you don't care
about getting the newest drug treatments, you may be okay to pass on
prescription drug coverage in your health insurance plan. Just be
sure that any drugs you're already taking are included in the plan
you choose.
6. Will my baby be covered on an individual health
insurance policy after it's born? The majority of health insurance
plans that offer maternity coverage will allow you to add your
newborn to an individual policy and convert it to a family plan. If
the newborn is added to the individual policy within 30 days of
birth, the plan typically won't require any medical underwriting.
But after 30 days, the newborn is subject to underwriting and may be
declined coverage, in most cases. Note: Some plans are "Individual
Only" plans, which don't allow newborns to be added to the policy.
If you have an "Individual Only" plan you'd need to purchase a
separate policy for your newborn and the child would be subject to
an underwriting review.