Many Expecting Mothers May Be Left Without Maternity Care Due To Health Coverage Loophole

By Consumers For Quality Care, on December 6, 2019

When they begin seeking care during their pregnancy, millions of mothers may be shocked to learn much of their maternity-related medical expenses might be out of pocket, even though they have insurance, CNBC reports.

One woman, Bethany, quickly found out only a fraction of her maternity expenses were covered by the insurance she got as a dependent on her parents’ plan.

Bethany and her husband had no idea insurance was going to be an issue, since she’s insured through her parents’ plan. But it turns out that was the problem. Bethany says her Michigan-based insurer, ASR Health Benefits, said her mother’s health insurance plan doesn’t cover maternity care for adult dependents and only paid a portion, about $1,000, of that initial OB-GYN bill that it deemed “prenatal care.” ASR did not respond to multiple requests by CNBC for comment and clarification of its policies.

The problem with Bethany’s insurance is that she was on her parents’ employer-sponsored plan. Employer plans cover maternity expenses for their employees, but they typically never covered these expenses for children or dependents. This is because under employer plans, coverage for dependents was traditionally cut off when children legally became adults or graduated college.

Under the Affordable Care Act (ACA), children are allowed to stay on their parent’s plan until they are 26. Although the ACA’s essential health benefits require plans cover maternity care, this rule did not apply to employer-based plans. So, Bethany now found herself without coverage for her maternity care.

In hindsight, it would be more affordable if Bethany was unmarried and therefore had a lower household income so she could claim Medicaid benefits, or if she taken out her own policy through a marketplace. While there are some federal laws that protect maternity rights, Bethany falls into a loophole.

Bethany’s situation is one that millions of potential mothers may soon find themselves in.

Currently about 4.2 million women ages 19 to 25 have coverage as dependents on their parent’s employer insurance plan, according to an analysis of 2019 Census data performed by New York University professors Ougni Chakraborty and Sherry Glied on behalf of the Commonwealth Fund for CNBC Make It.

The loophole leaves millions of young families vulnerable to huge bills every time they visit a doctor during a pregnancy.

On average, the cost for doctor’s visits range from about $90 to $500 per appointment, according to research site ValuePenguin. But then each additional service, such as ultrasounds, is billed separately and can range from $100 to $2,500 for special tests like amniocentesis.