In this series, we provide some of the key questions to keep in mind when tackling your health insurance. Here’s what to ask when you’re thinking about having a baby.
So you’re thinking about having a baby. There is no doubt that children are little bundles of joy, but there is really no bigger life change than going through pregnancy, labor and then caring for a new human being. You’ll need to plan ahead, and you’ll definitely want to research these three questions about your insurance coverage before making any big choices. If you don’t like what you hear, you’ll have the time to make some changes to switch up your coverage during open enrollment and be better prepared. If you’re already pregnant, you should still make sure you have these questions answered so you can know what to expect.
What maternity care is included in my coverage?
Almost all health insurance plans will have a coverage section devoted especially for pregnancy. You’ll want to read that closely, and, if it’s appropriate for you to talk about your pregnancy plans ahead of time, you can even set up a meeting with your HR or benefits representative to have them walk you through what is and what isn’t covered. Even though just about everything related to pregnancy and having a baby is new to you, the good news is that the whole process has happened literally billions of times, so insurance companies have lots of specific information, from the length of stay covered for a vaginal birth versus a caesarean, to learning if a circumcision is covered for your newborn son.
Having a baby is a qualifying life event, so you can add him or her to your existing plan or make changes after the birth before the next open enrollment season. During this process, it’s a good idea to take a closer look at what’s included for pediatrician appointments for sick/well visits.
What type of maternity/paternity leave is offered by my employer?
Knowing your health insurance coverage is a big piece of the puzzle if you’re planning to have a baby, but it’s not the only thing you should consider from a financial perspective. If you’re employed, finding out what type of maternity/paternity leave is included can make a big difference in your decision-making process.
Under the federal Family and Medical Leave Act, employers are required to provide employees job protected and unpaid leave for qualified medical and family reasons. Like anything enacted by the government, however, there are lots of different stipulations around the qualifications for FMLA, from how many hours one works to length of time as an employee. This FAQ on the Department of Labor website is a good place to get started.
The good news is that the FMLA is the bare minimum of what employers must provide, and many companies go above and beyond, offering paid leave for 12 weeks or even longer for new moms and dads. In many cases, states will also offer pay in the form of short-term disability for part of the leave.
It’s well documented that the U.S. is the only industrialized nation in the world to not offer mandatory paid leave, but the private sector has made strides in the last few years to help alleviate the issue.
Does my benefits package offer an FSA and/or a DCFSA?
One other big part of the equation when considering having a baby is to find out if you’re eligible for a Flexible Spending Account (FSA) and/or a Dependent Care Flexible Spending Account (DCFSA). Both of these are relatively new financial benefits offered by the federal government to help offset the cost of healthcare spending and childcare, respectively.
An FSA allows you to set aside a chunk of pre-tax money that you can use toward eligible healthcare expenses and includes things like co-pays to prescription drugs to breast pumps. Because the dollars are pre-tax, you save some money by not paying taxes on the funds you set aside. There are multiple online sites that detail what is and isn’t covered under an FSA, but the catch is that these dollars are “use or lose.” So, if you’re going to have a baby and know that your hospital stay co-pay will be $300, you can safely set aside that amount (and probably more) to help offset out-of-pocket costs. But you don’t want to go too high on this because you’ll want to have your balance be $0 at the end of your FSA eligibility period.
A DCFSA, meanwhile, is especially useful to help pay for childcare. Like an FSA, these are pre-taxed dollars that you can set aside, up to $5,000, to pay for daycare or a nanny. In today’s environment, it’s not unusual for both moms and dads to work and thus a DCFSA comes in handy to reduce costs for childcare.
These three questions are a good place to start, but as you can imagine, they’re just the beginning of the journey in knowing your costs when it comes to having a baby. Starting a family is a wonderful thing—but it is not cheap. Arming yourself with as much information as you can beforehand, can help you make some smart decisions and save some of the impact on your wallet.
SingleCare’s network of health professionals includes obstetricians and gynecologists, who can answer all of your questions throughout and following your pregnancy. Sign up to gain access to a transparent marketplace of healthcare prices, so you can find the right treatments and doctors at the right price for you.
* Prescription savings vary by prescription and by pharmacy, and may reach up to 80% off cash price.
Pharmacy names, logos, brands, and other trademarks are the property of their respective owners.
This article is not medical advice. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.