Christina Nicholson got an unexpected blessing last year. Her family of four was about to become a family of five.
The news of the new baby on the way wasn’t the biggest surprise.
After contacting her insurance company to find out which OB-GYN was in network, she found out she didn’t actually have maternity coverage as part of her plan.
Nicholson owns her own media marketing firm and was purchasing her own health insurance for around $500 month.
After exploring other health coverage options, she decided to drop her insurance plan and ask her providers if they could negotiate a self-pay price for the pregnancy and delivery.
“I said I’m not paying this money every month when it’s not going to cover anything,” said Nicholson, holding her son Dylan, whose now three months old. “Then, I started calling around and asking how much will it be to have this baby (without insurance) and I was actually surprised at how affordable it actually was.”
Nicholson said she negotiated a price of around $5,200, which included all of her prenatal appointments, labor and delivery with an epidural, plus a checkup after delivery.
The decision to self pay for her pregnancy was not her original intent. She thought she would have been able to get on another insurance plan that would cover the costs of having a baby.
The Affordable Care Act requires plans purchased through the marketplace to contain maternity coverage, but anything not considered an ACA approved plan is not required to cover a pregnancy.
“That’s when I found out that no insurance company will give you coverage if you are already pregnant,” said Nicholson.
She could have purchased maternity coverage on the health care marketplace during open enrollment, but her baby was due prior to when the open enrollment period began.
Pregnancy is not considered a special coverage event that allows for plan enrollment outside of the open enrollment window.
Nicholson’s last option for insurance would have been through her husband’s employee-sponsored plan.
She could have gotten onto his plan during his company’s open enrollment period, but Nicholson said that option would have cost their family more than $1,000 a month in premiums.
On top of the high premiums, she said the plan had a very high deductible, so her out-of-pocket costs would have been more than the self-pay price she was able to negotiate.
High deductible insurance plans are responsible for rising out of pocket costs for maternity care.
An article published in the January 2020 edition of Health Matters found that, on average, women with employer sponsored insurance pay $4,500 out of pocket to have their babies.
The study was conducted by researchers at the University of Michigan. It found that, while out-of pocket-costs rose every year from 2008 to 2015, during the same time period, the total cost to have a baby stayed relatively the same.
“Folks that are in a high-deductible health plan, that deductible may be $5,000. It could be $20,000,” said Dr. Michelle Moniz, an OB-GYN who coauthored the study.”You will have to pay that deductible before your health insurance kicks in for most health care expenditures.”
Nicholson said she still doesn’t have traditional health insurance because she believes the self-pay rate discount she gets by being uninsured continues to save her money. She said she has even gone back and compared old lab charges and office visits from when she had insurance and found that the self-pay rate is lower.
Nicholson also does not have to face a fine for going without insurance. A 2017 tax law removed the Affordable Care Act’s tax penalty associated with not having coverage.
“Obviously, everybody’s insurance is different. Everybody situation is different for me as a self-employed person paying out of pocket is cheaper,” Nicholson said.
WINK News is taking an in-depth look at health care in our Cost of Care series. If you have a story you want to be heard, whether it’s a high medical bill, an insurance dispute or a medical procedure gone wrong, send us an email to email@example.com.