Lower Premiums Can Cost More in Long Run With Maternity Care

Many plans in the individual market don't cover maternity care at all and women could be denied coverage if they are pregnant when they apply.

And even with the best planning, a woman may end up with an out-of-network provider, for example if the anesthesiologist on call when she delivers is not in-network.

Specific exclusions can also drive up costs for the consumer. Some policies, for instance, restricted coverage for PKU (Phenylketonuria) formula and for treatment for congenital or genetic birth defects such as cleft palate.

The details of the newer plans are also often difficult to figure out and language is often vague or ill-defined (such as "complications of pregnancy").

"It's really important for people, and particularly women of reproductive age, if they're looking at high-deductible health plans, to see if they cover maternity care, particularly if they're looking at the individual market," Salganicoff said. "We found very, very limited coverage of maternity care in the individual market."

In addition, women need to be aware that many aspects of pregnancy and delivery are hard to predict, meaning that costs could shoot up unexpectedly.

"If you're getting an emergency C-section, you're not at the point where you're going to shop around for the best price," Salganicoff said.

Responding to the report, Carol Pryor, senior policy analyst with the Access Project in Boston, said, "Consumer-driven health care is based on the assumption that if you require people to spend their own money on health care, they will become more informed consumers. In this regard, many have pushed providers to become more transparent in their pricing. This report makes clear, however, that insurance contracts are so confusing and opaque that it is almost impossible for consumers to make rational decisions about which health plans to purchase.

"While consumer-driven insurance policies may offer lower premiums, the almost impossible to predict out-of-pocket costs under these plans can leave consumers at serious financial risk, threatening their access to needed care as well as their economic security," she added.

More information

Visit the Kaiser Family Foundation for more on the report.

SOURCES: Alina Salganicoff, Ph.D., vice president and director, Women's Health Policy, Kaiser Family Foundation, Menlo Park, Calif.; Carol Pryor, senior policy analyst, the Access Project, Boston; June 12, 2007, Maternity Care and Consumer-Driven Health Plans

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