Maternity: Financial Considerations and Insurance For South Florida Residents

So you are thinking about starting a family or having another child and you are wondering about costs and how to pay for the birth of a child.  Proper planning of the financial side of growing a family is important. First, you and your partner decide on the number of children you are planning to raise and a rough timeline between births for those who contemplate families. The financial decisions you make will vary greatly depending on how you answer that question. Second, you need realize that today almost 40% of children born in Florida are via C-section and that Cesarean deliveries are almost twice as expensive as vaginal births.   Realizing this should also be a factor in financial family planning.  

So what does it cost?  

The June 5th edition of the Orlando Business Journal indicated that in Florida C-Sections average between $11,000 to $20,000 and in Hialieah one facility charges up to $30,826. Vaginal births average between $6,000 to $11,000 across the state. The variance is quite large and communicating with the facility you plan to use will give you a better idea of the costs you will encounter. This is confirmed nationwide by a study by the Kaiser Foundation which indicates that vaginal births cost half the price of C-sections and that private insurance patients (including network discounts) average a total cost of $13,000 for C-section deliveries.  

What do you do if you can't afford insurance.  

There are four options for those planning to have a child without insurance. The first, getting a job with a company that provides group benefits is not the easiest of options and in the current environment, is probably not a choice someone should bank on. You may find some relief if you can afford the Cover Florida Plan that were developed with the guidance of Governor Crist.   

There are two additional government programs for which you may qualify. "Women, Infants, and Children", a federal program provides assistance to women who meet their guidelines. You can get information about this program and how it works in Florida by going to their website.   

Another program that is available for some women is through Medicaid. The department that handles Medicaid in Florida is theFlorida Department for Health Care Administration.  

The last option is to negotiate a price with the facility you are planning to use. Many hospitals will provide payment plans and negotiate with people regarding maternity. For other costs regarding financial planning on beginning a family go to eHOW and read their article on estimated costs of having a baby.  

What about insurance?  

Group Insurance: Most companies that offer group insurance have policies that will cover the birth of a child. While you may have deductibles, coinsurance, and copayments you have the benefit of pre-negotiated rates and that usually is the best option. Maternity coverage is one of the reasons that group insurance is so costly. To qualify for group insurance you must work for a company that offers this insurance or if you own your own company with at least two employees, you may be able to start a group insurance plan.  Florida companies with only one employee can also get group insurance during a special period in August of each year. 

Individual Insurance: In Miami-Dade, Broward, and Palm Beach Counties most of the individual health insurance companies offer NO maternity coverage whatsoever. As of Oct. 2009 some of the companies without coverage are Aetna, Avalon, Cigna, Coventry's PPO, and HumanaOne. This leaves the following companies which DO provide some form of coverage. Assurant, AvMED, Blue Cross / Blue Shield of Florida , Golden Rule (United Healthcare One), and Vista. Although they cover maternity, when that coverage begins can dramatically vary.  

Golden Rule merely requires you to have maternity coverage in force prior to getting pregnant. The downside of their maternity program is that they dramatically restrict their maternity liability during the first two years of the coverage and usually the cover only a small percentage of the maternity costs. Similarly Blue Cross / Blue Shield of Florida has a requirement that you have maternity coverage in force for thirty days prior to conception and their plan includes a separate deductible of either $1500 or $2500. After that they cover only 50% of the costs up to a limit of $5,000. You should be aware that this limit may cost you to bear the majority of the expense, especially if a C-Section is involved  

AvMED, which has a twelve month waiting period prior to getting pregnant, will cover 100% of the maternity costs, but they have a $5,000 maximum and again you may find yourself both waiting and with a substantial liability.  

In the authors opinion, the two best maternity options are from Assurant and Vista.  The Assurant plan has a three month waiting period, a separate deductible, and then covers 100% of the maternity costs in-network. They allow you to choose among several networks, and you can even call them and change your network should that become necessary. The Vista plan has a whooping fifteen month waiting period but once you are past that you need only pay for the first OB-GYN visit with a $50 copay and a $1000 Copay for the birth. Everything else is 100% covered.  

So how do you choose which one is best. If you have time and are planning for many births, either the Assurant or the Vista plan make the most sense. If you are confident that vaginal birthing may be a viable solution and you can cover the costs then the Golden Rule or perhaps the Blue Cross approach may be the best option. If you need help in reaching this decision the author can be reached at wkohn@ebmsi.com.