Maternity Gap in High-Deductible Plans
Childbirth and Pregnancy Often Uncovered in Plans
June 12, 2007 - If you’re thinking about having kids, exercise the axiom
“buyer beware” before signing on to high-deductible health insurance.
That’s the advice coming from several experts on the heels of a study
showing that young families can face staggering out-of-pocket costs with the
increasingly popular plans.
A study released Tuesday shows that most so-called
"consumer-directed" health plans fall short in their coverage of
maternity costs. Some of the plans don't cover maternity costs at all, experts
say, and those that do can leave beneficiaries to shoulder high costs.
The costs can top $20,000 if pregnancy complications arise, according to the
study. That can leave young families on the hook for thousands -- sometimes
tens of thousands - of dollars.
“This is something most people are just not aware of,” says Alina
Salganicoff, director of women’s health policy at the Henry J. Kaiser Family
Foundation, which commissioned the report.
The study analyzed 12 popular consumer-directed plans and looked at how much
spending in the form of deductibles, co-payments, and uncovered services a
patient might have to pay.
Assuming an uncomplicated pregnancy ending in a vaginal birth, patients
would pay between $1,455 and $7,884 out-of-pocket, depending on how generous
the consumer-directed plan. The typical uncomplicated pregnancy runs about
$14,000 in total cost.
But a complicated birth requiring a cesarean section, early labor, or a
newborn stay in a neonatal intensive care can balloon out-of-pocket costs to
$8,800 for the most generous plan and a staggering $21,200 for the least
“Families could be liable for $15,000, $20,000, $22,000 for the cost of
care,” warns Karen Pollitz, a Georgetown University researcher who co-authored
As many as 4.5 million Americans are now using consumer-directed plans for
their coverage. The plans’ lower premiums and wide choices offer an attractive
alternative, especially to people who can’t afford other forms of coverage.
Employers like the plans because they can contribute a set amount of cash into
a tax-free account without being on the hook for rising health costs.
One tradeoff is the plans’ high deductibles, sometimes reaching $5,000 or
higher per year for individuals and $10,000 for families. Because few of the
plans cover maternity services unless customers buy special riders, those
deductibles can be easily reached, experts say.
Young families could even find themselves paying their annual deductible
twice if their pregnancy spans two calendar years. For a nine-month pregnancy,
the odds are good that will happen, Pollitz says.
Health insurers promote consumer-directed plans as a good alternative to
expensive group coverage. Tom Wilder, vice president of America’s Health
Insurance Plans (AHIP), an industry lobbying group, says the lower up-front
offered by the plans give many Americans access to coverage they otherwise
One industry study shows that premiums for some consumer-directed plans are
nearly 40% lower than other employer-sponsored group coverage. “That’s less of
a cost that you’re going to have coming out of your pay check,” Wilder