The Cost of Healthcare: Couples in Consumer-Driven Health Plans Pay More for Pregnancy
If you're planning to get pregnant anytime soon, consider your health insurance first. A new study has found that families enrolled in a consumer-driven health plan (CDHP) can expect to pay significantly more out of pocket for maternity care than families in a traditional plan. For a normal vaginal delivery, a family with a CDHP might pay between $3,000 and $7,000 out of pocket compared with just $1,455. For more complicated maternity care—a cesarean delivery, for example, or preterm labor and neonatal intensive care—the out-of-pocket costs for families in CDHPs might run from $3,500 to more than $20,000.
Pregnancy and childbirth are among the most common medical expenses, accounting for nearly 25 percent of all hospitalizations each year. For the study, researchers from the Georgetown University Health Policy Institute and the Kaiser Family Foundation compared average maternity costs for a family covered by a traditional plan carrying a $500 family deductible with 12 consumer-driven plans carrying deductibles ranging from $3,000 to $10,000. These plans were generally linked to a health savings account to which employers and individuals could deposit money to cover some medical costs. To date, only about 4.5 million people are covered by a high-deductible plan with an HSA. But these plans have attracted plenty of attention in recent years and are touted by some politicians and policy experts as a way to stem rising healthcare costs by encouraging people to be more prudent healthcare consumers.
Because of the higher deductibles of those plans, researchers expected people in them to pay more. But the magnitude of what they would owe was unforeseen. "We knew the numbers would be big, but when you actually do the math, it was breathtaking," says Karen Pollitz, a research professor at Georgetown University Health Policy Institute who coauthored the report.
In addition to calculating costs for a straightforward vaginal birth, researchers tallied out-of-pocket charges for a hypothetical cesarean delivery without complications and for a complicated pregnancy in which the woman suffered gestational diabetes, went into preterm labor and required hospitalization, and whose baby had to be in the neonatal intensive care unit for several weeks. Out-of-pocket costs for the cesarean delivery would run about $2,200 under the traditional policy, and between $3,500 and $9,800 under a CDHP. A family that experienced the very complicated pregnancy described by researchers might pay $8,700 under a traditional plan or a whopping $14,000 to $21,000 under a CDHP. (There was one exception: Under one CDHP, the family's costs would actually be $6,000, lower than under the traditional plan, because that particular policy didn't require cost sharing for maternity or inpatient care once the deductible was met.)
One important issue for many people: The nine-month period covering pregnancy and delivery often spans two calendar years, so they must satisfy two deductibles before coverage kicks in. But it wasn't only higher deductibles that increased people's out-of-pocket costs. Consumer-driven plans generally have higher out-of-pocket maximum limits as well, so that a complicated pregnancy or delivery can mean families have to pony up much more before insurance starts covering all or nearly all their bills. In addition, although many CDHPs cover preventive care without making it subject to the deductible, researchers were surprised to find that most CDHPs didn't consider prenatal care preventive.
Noting that CDHPs seem to be especially popular with generally healthy people who don't imagine ever reaching much less exceeding their deductible, study coauthor Alina Salganicoff, vice president and director of women's health policy for the Kaiser Family Foundation, says, "You can be an otherwise healthy, active woman and still experience a birth that has complications. A third of births do. There's no way to predict what your situation will be."