Additional coverage from Medicaid will provide lower-income pregnant women who have signed up for insurance coverage through Obamacare a chance to save on medical bills. The added coverage will be available in all states, allowing some women to save hundreds of dollars on their share of bills from pregnancy and childbirth. Although the coverage will be available even if an individual state does not expand its Medicaid under the Affordable Care Act, states will have different income levels for eligibility.
Medicaid already pays for approximately half the births in the U.S., but Medicaid coverage for pregnant women does not meet the “minimum essential coverage” requirement under the new health law, according to a Treasury Department ruling last summer. This is because the Medicaid maternity-only coverage is temporary, running out after the baby is born. And states can restrict what services their Medicaid coverage will pay for.
Initially the Affordable Care Act would not allow enrolling in both Medicaid and government-subsidized private insurance. Although the Treasury Department ruling came last summer which allowed pregnant women to have both forms of coverage, the program was not set up into the computers until recently. Another barrier is that much of the public does not know about the latest change, and that once they do know about it they may not know how to navigate the system and get signed up.
It is uncertain how much the new Obamacare maternity options will cost the government, but it is expected that it will save a substantial amount of money for pregnant women. A normal healthy childbirth costs about $5,000, and complicated deliveries can run much more, with copayments and deductibles that are the responsibility of the patient. Having Medicaid to supplement insurance coverage and pick up many of these costs could save hundreds or even thousands of dollars for pregnant women.
Cynthia Pellegrini, who heads the Washington office of the March of Dimes, said many women are not thinking about maternity coverage when they sign up for insurance on the Affordable Health Care act insurance exchange, but are just thinking about the monthly premium. She says about half of U.S. pregnancies are unplanned, so high out-of-pocket costs for pregnancy coverage may come as a big surprise.
Although the expanded coverage under Obamacare may cost the government more, there are savings expected as women get better prenatal care, which is shown to prevent birth defects and premature births. Pellegrini says the March of Dimes works to promote healthy pregnancies and prevent birth defects, so protecting pregnant women from high out-of-pocket costs could help with this goal.
Reprogramming federal and state computers is the major obstacle now, changing the systems to recognize that some pregnant women have a right to coverage by both Medicaid and insurance exchange private plans. They can now pick Medicaid, insurance, or both.
Before the Affordable Care Act, maternity care was covered by only 12 percent of individual market insurance plans according to the National Women’s Law Center. Starting in 2014 maternity services were included in the list of essential services that must be provided by all new health insurance plans offered under Obamacare, meaning pregnant women have new options for substantial savings on medical bills.
By Beth A. Balen
San Jose Mercury News