If you live in Arizona and want to become pregnant, you should be aware that a normal delivery, meaning a delivery in which no medical complications arise, can cost you more than $10,000.
(If you are already pregnant, click here to read about what options you may have.)
Almost all of the individual/family health insurance plans available in Arizona do not include maternity benefits. This is a relatively recent development, as most of the companies have slowly dropped their maternity plans over the last few years. By law, they all do include “complications of maternity” benefits, but that does not mean you have maternity coverage if you are on one of those plans. Today, a c-section surgery is usually not considered a complication of maternity, and in all likeliness, a c-section would have to be paid by you, not your insurance company. A c-section can add an additional $5,000 to that $10,000 figure mentioned above.
Here in Arizona, there is only one major health insurance company that still offers an individual health plan with maternity coverage — HealthNet. (The other companies in AZ, such as Blue Cross Blue Shield of Arizona, Cigna, Humana, and United HealthCare / Golden Rule have all discontinued their maternity options.) If you are a female, 25 years old and live in Phoenix, the monthly premium for you on the HealthNet plan is $445.
On this HMO plan, you must be covered for 12 months before you become pregnant. Prenatal care and delivery costs are not covered unless you deliver your baby 21 months after your policy starts. You have a deductible of $3,500, then you pay 30% of your remaining bills, up to a maximum of another $3,500 over and above your deductible. 21 months of paying the monthly premium of $445 adds up to $9,345. Add another $3,500 deductible and up to another $3,500 in co-insurance, and your total out of pocket costs to have your baby becomes pretty expensive. (Click here to download the HealthNet HMO brochure.)
However, there is another solution to these extremely high costs that works well for many people. A lot of Arizona hospitals, especially those located in Phoenix and Tucson, offer steeply discounted rates to cash-paying customers that use their birthing centers. The rates vary, but for a normal delivery expect to pay about $3,000-$5,000 for your delivery, in addition to doctors’ fees.
If you purchase a health insurance policy that does not include maternity benefits, your monthly premium costs are much less than those that include maternity benefits. As an example, a very good Blue Cross policy for a female at age 25, living in Phoenix, is $100-150 per month. You can purchase the plan without maternity coverage, have your baby ten months later, pay cash to the hospital, and win every way you look at it — you DON’T have to wait 21 months to have a baby, and you don’t have to pay over ten thousand dollars out of pocket to have your baby. If anything major goes wrong during your delivery, you don’t need to be concerned with emergency costs, because your policy, even though it does not provide maternity benefits, DOES have “complications of maternity” benefits. Also, your existing health insurance policy will cover your new baby immediately. (Here is a PDF from Blue Cross Blue Shield of Arizona that lists hospitals offering maternity packages.)
The non-maternity coverage scenario does not work for everyone, particularly those women that have had difficult deliveries or pregnancies in the past. But odds are in your favor that it will work for you.
Call us at (800) 600-9663, and we’ll try to give you the best advice for your circumstances. Click here if you’d like us to send you a quote of your different health insurance options in Arizona.
If you have a low income, you might qualify for AHCCCS, Arizona’s Medicaid program for low income residents. (More than half of the babies born in Arizona are paid for through AHCCCS!) For more information, visit Baby Arizona.
* Please note that this information regarding maternity coverage relates to individual / family coverage in Arizona. If you have the option to join a group plan through an employer, that is probably your best option. All group plans in Arizona are required to offer immediate maternity coverage, even if you are already pregnant.
The maternity riders are designed to take in more in premium than is paid out in premium – as is the case with any health insurance plan. With maternity, the event is planned in advance by the buyer, and the benefit for normal delivery is fairly certain, so there are few ways for couples to come out ahead.
Your approach of suggested discount birthing centers make sense. Couples can consider purchasing supplemental insurance which covers normal maternity with no waiting period or deductible. Benefits are paid directly to the insured. Ask your employer to make a voluntary option available.
What if you move to Arizona and are already covered in your home state with maternity coverage? Does the 21 month waiting period still apply if you are just simply switching the same coverage to a different provider in a different state?
Hi Caitlin- it depends what type of plan you have and which insurance company you are with. If you are able to keep your coverage, then you should be fine. If your insurance company does not offer coverage in Arizona, you will probably need to re-apply for new coverage.