Pa health insurance with maternity coverage is available through this website, Pennsylvania’s leading online website for pregnancy, delivery, and childbirth benefits. We make it easy for you to find health insurance plans that include prenatal benefits. Individual medical plans for pregnant women will generally cover many of the associated expenses, such as prenatal doctor visits, lab work, ultrasound, delivery fees and hospital expenses. Marketplace, Group, and Medicaid plans typically provide comprehensive coverage, although out-of-pocket expenses will vary.
Childbirth and maternity care are considered “essential health benefits,” and are therefore mandated to be covered under single and family qualified medical plans (began in 2014). If you are pregnant at the time you apply or enroll, benefits will still be included and there will be no waiting period or forced reduction of benefits. You also will not pay a higher premium, or forced to accept higher copays, coinsurance, or deductibles.
Complications, including cesarean deliveries, are also covered on Marketplace and Affordable Care Act-approved policies. We help you find the plans that cover you and your future baby as inexpensively as possible with no waiting periods. If you qualify for a federal subsidy (we can quickly calculate your eligibility amount) it’s possible that a large portion of your premium will be paid by an instant tax credit.
How Does The Federal Government Help?
Prior to 2014 (although the legislation was actually signed into law in 2010), maternity benefits were typically excluded on private individual plans. Several carriers offered riders to add coverage although there was a waiting period, and the annual cost of the rider often was more than $5,000 per year. If you were already expecting a child, your application would be instantly denied, although employer-sponsored group plans generally included this type of benefit if you were a full-time worker.
Pregnancy is no longer considered a pre-existing condition (including complications) in Pennsylvania or any other state. If you apply for coverage during Open Enrollment, no medical questions will be asked. It does not matter if you are in your first or third trimester, or just suspect you are pregnant. There are no questions on the short enrollment form that ask you to provide any related information. Also, once you deliver your child, he (or she) is eligible to apply for coverage with full medical benefits.
A “Special Enrollment Period ” (SEP) is also offered if you forgot to apply for a policy or missed the deadline. However, this SEP exemption covers your newborn, but not yourself, unless you also qualify for an exception. NOTE: If you are a federal employee or retiree, coverage is offered by GEHA, which is a non-profit association. Information on pregnancy and prenatal care is provided, along with a free book, “Your Pregnancy And Childbirth,” which is authored by the American College of Obstetricians and Gynecologists. A nurse consultant is also available for assistance.
You also can no longer be canceled because of a paperwork or clerical error, and there are no annual or lifetime limits for the treatment you receive. Obstetrics and gynecology visits do not have to be pre-authorized, and of course, no copay or deductible applies to the cost. Complications from pregnancy, including C-Sections are covered. Out-of-pocket costs, and cost of policies, will vary, depending upon your age and county of residency.
Some of the most common benefits found on qualified plans include:
Inpatient Services – Hospital and Emergency-Room expenses, cost of physician fees, nurse fees, specialist fees, surgeries, and cost of room and board.
Outpatient Services – Physician visits (both prenatal and postnatal), specialist visits, lab tests, x-rays, gestational diabetes screening, prescriptions, required counseling and Hepatitis B screening.
NOTE: Recently “WiseBread” published a comprehensive list of US employers that offer the best maternity benefits. The companies at or near the top of that list included Deloitte, General Mills, Proctor & Gamble, Abbott, IBM, Yahoo, Twitter, Google, and Prudential.
Best Plans For Maternity Coverage in Pennsylvania
Since benefits are fairly standard (with some exceptions), limiting deductibles out-of-pocket expenses and ensuring there are many network-approved OBGYNs and medical facilities are the principal criteria to determine your best options. We have listed below the plans that best meet those criteria. NOTE: Since each household situation is unique, it is possible that plans not listed may also be worth considering. Our list is designed as a general guide and not a final recommendation.
The estimated out-of-pocket expenses are calculated on a 40-year-old husband and wife with household income of $40,000. Silver-tier plans are utilized because of their unique “cost-sharing.” Figures shown should not be used as a cost-estimator, since actual expenses and utilized benefits will vary.
Plans And Estimated Out-Of-Pocket Expenses For Having A Baby (Hospital Delivery And Nine Months Of Prenatal Treatment)
UPMC Advantage Silver $2,650/$25 – $3,600
UPMC Advantage Silver $0/$50 – $5,910
UPMC Advantage Silver $1,425/$50 – $5,270
In the past, when an Aetna HMO plan was used, you had to select a Pennsylvania Participating Primary Care Physician (PCP) and use services within the service area. Two exceptions would be an emergency or urgent situation. Since Marketplace plans from Aetna are not offered, the PCP rule applies mainly to Group contracts. A full list of benefits and exclusions can be provided. Aetna’s network is extremely large and finding a doctor or local hospital is quite easy. If you are traveling out of the area, benefits are still provided. But staying within the network saves you the most money. If you are employed, you may be able to purchase this contract through your employer, as long as it is made available to all employees.
For the central part of the state, Geisinger is a great option. Maternity benefits are comprehensive, and the rate is extremely affordable. Geisinger is one of the most respected carriers that offer this type of coverage. But their rates are the most attractive in the Harrisburg area and surrounding counties. They feature many plans with low deductibles (such as $250 or $500). Capital Blue Cross has a large provider network in Harrisburg and surrounding areas, so they also should be considered too.
Best Western Pennsylvania Healthcare Plans
Western Pennsylvania residents can get comprehensive coverage from Highmark and UPMC. Benefits on popular plans are provided at 80% or 90% after the deductible is met. There are various deductible options including a low $1,200 choice. Most area hospitals will accept their treatment. We’ll be happy to help explain the benefits and provide current rates.
Highmark BCBS offers the Comprehensive Care Blue 500 (mentioned above) in the Platinum tier with a $500 deductible and low $1,650 maximum out-of-pocket expense. The coinsurance is 10% and the plan is eligible for federal subsidies.
UPMC entered the private Exchange market in 2014, and in certain counties, has very competitive options. Their plans provide choice benefits after the selected deductible has been reached. Prenatal, post-delivery and postpartum care are all included. The Advantage Platinum $250/$20 plan (Both Select and partner Network) provide a low $250 deductible and maximum $1,500 out-of-pocket expenses.
And In The Philadelphia Area…
In the Philadelphia area, including the counties of Bucks, Philadelphia, Chester, Montgomery and Delaware, the Keystone HMO Copay plans include these benefits. There is a daily copay and benefits are very comprehensive. In many situations, the rate will be lower than Aetna. But coverage and service is limited to those five counties. If, for example you live in that area but spend extended time in other ares of the state (or outside of the state), the Keystone option may not be the best fit.
Another option is to purchase a Pa Health Savings Account, which is available from most major insurers. Deposits into a Health Savings Account reduce your taxable income as long as these funds are used on qualified medical expenses (as defined by the IRS). You can deposit funds into your HSA that can be later used to pre-fund expected routine expenses.
Funds would be considered pre-tax and could potentially save thousands of dollars in expenses. Also, you may be eligible for a “negotiated network discount” on your expenses if you have qualified health care. However, if you want to minimize your out-of-pocket costs and/or know with fairly strong certainty that you will become pregnant within the next 12 months (or already are), a Platinum or Gold-tier policy is generally a better choice.
Medicaid And Pregnant Women
Medicaid pays (partially or fully) for two out of five births in the US. Coverage is very comprehensive, with prenatal care, delivery, labor, and two months of postpartum expenses included. Any child born to a Medicaid-eligible applicant is typically automatically covered for 12 months regardless of citizenship.
Healthy Beginnings provides Pa medical assistance for qualified individuals. Benefits can start at the time a nurse or physician informs you that you are pregnant. You can enroll for coverage online or through the County Assistance office.
For additional information on Pa health insurance with maternity coverage, please call us at (888) 513 6446 or request a free rate quote at the top of the page. You’ll be able to compare or apply online for the best prenatal care for you and your baby.