On September 25, 2014, Nancy sat me down and gave me the big news: “I’m pregnant!”  We enjoyed the day and celebrated.  The next morning, however, I pulled out our insurance policy and started reading.  I wanted to know – what’s all this going to cost?

Over the next few weeks, I got into it pretty deep with our prospective healthcare providers and our insurance company.  I called Blue Cross Blue Shield of NC multiple times, and, to their credit, all of their reps were very helpful.  Finding out about real costs, however, was a challenge.

I’m gonna be real transparent here: I’m not, nor have I ever been a fan of Obamacare/the “Affordable Care Act.”  I’m not going to get into a political discussion, but it’s not making things “more affordable.”  (BCBSNC just reported a $50.6 million loss for 2014 because of rising costs under the ACA, it’s first loss in two decades. That’s utterly unsustainable.)  That being said, Obamacare has some implications that you need to be aware of when making your healthcare choices.

When understanding your insurance costs related to pregnancy, two numbers matter, and you need to know them: your premium and your out-of-pocket limit.  Your premium is the amount you pay on a monthly basis to have the insurance plan.  The out-of-pocket limit is the maximum you would pay for your share of covered expenses in one year (or your standard benefit period).  Out-of-pocket limits from BCBSNC can range from $1500 to at least $11,000.

While understanding your deductible and coinsurance is helpful, you are virtually guaranteed to hit that out-of-pocket limit if you deliver in the hospital.  Your obstetrician likely has a global fee (covering everything) of between $4000 and $8000, and the hospital is going to cost at least another $8000, while WakeMed Hospital here in Raleigh quoted me $13,000(!!!).

Look over your policy or get a rep on the phone and find the answer to these two questions.  1) How much do I pay each month for this plan, and 2) What is the most I would pay for my share of benefits in one year aside from that?

Our previous plan was a high-deductible health plan (HDHP) with a Health Savings Account (HSA).  We love that plan, and it’s great for healthy families.  The HSA allows you to save tax-free money for healthcare expenses.  Upon reviewing our plan, I understood that our out-of-pocket limit was $11,000, and our total insurance costs to have this baby would be up to $11,000 plus our monthly premium for the 10 months of pregnancy.

As I got deeper into research, I began to compare the cost of our current plan to other plans that BCBSNC offered.  Doing a simple comparative analysis, I looked at four different plans, each one having different premiums and out-of-pocket limits.

“But wait.  How can you get a new insurance plan when you’re pregnant?” you may ask.  Here’s where it gets interesting.

As you may know, coverage for “pre-existing conditions” were a major part of the healthcare overhaul.  If you buy your own insurance, you know that when applying for health insurance, they now ask for one identifying thing: your age.  Beyond that, they ask for nothing – you could have just received a cancer diagnosis, you could be lying on your death bed, and they will give you insurance for the same price as anyone else.  Crazy, huh?

I don’t really like taking advantage of a law that I wasn’t in favor of, so I don’t love this part.  However, I didn’t create the rules; I just have to play by them now.  I have a responsibility before God to be a good steward of the money that he has entrusted to me, so if I can save several thousand dollars with a simple plan change, I’m going to do it.

Furthermore, Blue Cross (or whomever) will charge healthy, active twenty-somethings like me the same amount as someone with cancer, diabetes, or any exorbitantly expensive condition.  That being the case, I don’t have any problem using an advantageous healthcare plan for a few months, and you shouldn’t either.

Now it doesn’t matter if you’re pregnant, you can switch to a different insurance plan.  We were lucky that the open enrollment period fell right around the mid-point of Nancy’s pregnancy.  Not everyone will be that lucky (likely including us, next time).  Other than open enrollment, you can only change your insurance plan if you have a qualifying life event:

– Job loss/change (and you lost your insurance)
– Aging out of your parents healthcare coverage
– Birth or adoption of a child
– Gained citizenship
– Moved to a new state
– Other exceptional circumstance

Some of these can happen during a maternity period, so you may become eligible for a new plan even though open enrollment doesn’t happen during your pregnancy.

After comparing the total costs of the plans I considered, we went with the Platinum plan for Nancy (literally it has the name “Platinum”).  Its monthly premium is double what we used to pay, but has an out-of-pocket limit of $1500.  It’s not hard to see how it cost less than if we had kept our original plan with the out of pocket limit of $11,000.  Meanwhile, I stayed on our HDHP with HSA.  All in, I estimate our cost savings from that simple switch at around $4000.

So if you’re pregnant or considering trying to start a family, re-evaluate your insurance.  What is your premium + out-of-pocket limit?  Would a more expensive premium actually be worth it?  Is there an open enrollment period coming up?  Have you, or will you soon, experience a “qualifying life event” that will allow you change your healthcare plan?

For health insurance shopping nationwide, I like eHealthInsurance, because they shop multiple providers.  Here in North Carolina, Blue Cross Blue Shield of NC is also certainly worth a look.

What do you think about all this?  Am I hypocritical?  What has your experience been with maternity insurance coverage?