There’s no better time to think about your health insurance coverage than now, whether you’re expecting your first baby or planning for one in the future. As your family grows, so do your needs, and ensuring that your health insurance provides the right coverage is essential. Whether you’re looking to update your current policy or shop around for a better deal, it’s important to ask the right questions and get the best coverage for both you and your baby.
This quick guide will help you navigate the key questions to ask your insurer, so you can make an informed decision and ensure you’re getting the best value.
Coverage with Medicare and Private Health Insurance: Pregnancy and Insurance
In Australia, Medicare will cover your pregnancy and childbirth care in any public hospital or birth center, including homebirth programs. However, if you prefer the services of a private obstetrician or a private hospital, you will need additional private health insurance to cover the associated costs.
Private health insurance can provide peace of mind if you choose to deliver your baby privately, but before you commit to any policy, there are important factors to consider.
Questions to Ask Before Purchasing Health Insurance
The Commonwealth Ombudsman advises that you ask the following questions before signing up for a health insurance plan to ensure you get the coverage you need:
1. What Pregnancy and Childbirth Services Are Covered?
Some health insurance policies, particularly more affordable options, may exclude obstetric services or impose restrictions, such as only covering you if you’re a private patient in a public hospital. If you choose to deliver your baby in a private facility, this could leave you with significant out-of-pocket costs. Be sure to confirm that the policy covers the entire range of services you’ll need during your pregnancy, birth, and postpartum care.
2. Does the Policy Cover My Baby?
It’s essential to check that your hospital insurance covers newborns. Ideally, this coverage should include your baby from the moment they are born and should not have any waiting periods. If your baby requires immediate medical attention, such as admission to a neonatal intensive care unit (NICU) or special care nursery, you want to ensure that these costs are covered. Additionally, check for any additional charges if you’re expecting twins or multiples, as this can increase your medical expenses.
3. What Are the Excess Payments for Mom and Baby?
You must understand the excess payments or co-payments required for both you and your baby. Some policies may require higher excesses for certain services, such as a C-section or epidural. Be sure to ask what your financial responsibility will be and if there are additional costs for both mother and child during the hospital stay.
4. What’s Not Covered?
It’s just as important to understand what is not covered under your policy. While insurers often highlight their benefits, it’s essential to read the fine print and make sure you’re aware of any exclusions. For example, some private hospital policies may not cover certain hospital fees, specialist consultations, pediatrician visits, or other essential healthcare services during your pregnancy and after the birth. Knowing these exclusions will help you avoid surprises later on.
Balancing Must-Haves and ‘Nice-to-Haves’
When selecting a policy, it’s crucial to identify your essential needs and separate them from those “nice-to-have” extras. For example, pregnancy massage may seem like an unnecessary luxury to some, but for others with chronic musculoskeletal issues, it could be a vital form of care during pregnancy. Evaluate what’s important for your specific needs and what you can forgo. This will help you avoid paying for benefits you don’t truly need.
Additional Considerations
When evaluating your pregnancy health insurance, there are a few other important factors to consider:
5. Waiting Periods
Keep in mind that all health funds in Australia impose a 12-month waiting period for obstetrics services. This means that you need to have held the appropriate coverage for at least one year before you’re eligible to be admitted for pregnancy-related care. If you’re planning a pregnancy shortly, make sure to get coverage in place as early as possible.
6. Coverage for Infertility and IVF
If you’re planning to use infertility treatments, such as in vitro fertilization (IVF), be aware that most obstetrics policies do not cover these procedures. Some policies may provide limited coverage for aspects like hospital stays related to IVF, but these services are generally subject to a longer waiting period—sometimes up to three years. Be sure to discuss your IVF needs with your insurer if this is part of your family planning.
7. Dental Care After Pregnancy
Pregnancy hormones can affect your dental health, leading to issues like gum disease or an increased risk of cavities. It’s worth checking your policy’s coverage for dental care, especially for post-pregnancy checkups and treatments. Some health policies offer basic dental coverage, which may be useful for your oral health after childbirth.
Tips to Save Money and Maximize Your Coverage
Health insurance can be expensive, but there are several ways to ensure you’re getting the best value:
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Join Early: If you join a health insurance fund before turning 31, you can avoid the Lifetime Health Cover (LHC) loading, which increases your premium if you join later in life.
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Understand Your Needs: Pay attention to what you need in coverage. Avoid purchasing unnecessary extras that don’t align with your priorities.
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Compare Policies: It’s crucial to compare different policies to find the best one for you. Be cautious of comparison websites, as they might favor certain providers. Make sure to compare policies independently to find the best match for your needs.
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Don’t Overpay for Extras: Be realistic about the coverage you need. You may not need every extra available, and opting for a policy with fewer extras can lower your premiums.
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Review Regularly: Health insurance policies and the healthcare market can change over time. Regularly review your policy to ensure it still meets your needs as your family grows.
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When You Start a Family, Ask Yourself These 5 Questions About Health Care.
Before I even knew I was pregnant, I thought about what to call the little one and how long I would wait before finding out its gender. I then realized that my most important questions concerned the health coverage of my future pregnancy and newborn. By researching your options for insurance before becoming pregnant, you will know what to look out for when open enrollment comes around. These are the top maternity insurance concerns you should be focusing on:
1. Which Doctors Will I Consult During My Pregnancy and Why?
You should take a close look at your relationship with your OB/GYN if you are trying to conceive. After all, this is the person who will deliver your baby. It’s helpful to ask family and friends for recommendations when you are looking for a new midwife or obstetrician. You can also look for recommendations on mom-focused Facebook pages or on websites that offer doctor reviews.
Find out if any of these doctors are in the network of your prospective plans. You’ll save on maternity and delivery costs if you choose a doctor in your network. Aetna Members can use DocFind to view patient ratings and reviews of in-network physicians. The same process can also be used to choose a pediatrician.
2. Which Hospital or Birthing Center Will I Deliver My Child To?
You’ll need to know which hospitals your midwife or OB/GYN has admitting privileges at after you choose them. If an obstetrician does not have these privileges, the hospital may refuse to accept you for treatment. Ask the office or check their website to see if they have any affiliations with hospitals. Visit the website of your health insurance company to determine if those hospitals are part of your plan. Aetna DocFind lets you search for hospitals in your network, and also for those with special awards for breastfeeding support or baby safety.
You’ll have to choose which option you prefer if you are lucky enough to be able to make a choice. For this reason, many hospitals offer tours of the maternity ward. Ask yourself these questions during the tour:
- Clean? Secure?
- Are the rooms large? Will you be sharing a room with a new mother? Will your insurance cover a private bedroom if that’s what you prefer?
- Does your partner have the right to share a room with you?
- Will your baby share a room with you, or will it be in a separate nursery from the rest of the family?
3. What Coverage is Provided By My Health Insurance Plan for Maternity?
You’ve chosen the health professional and facility that you’d like to visit, and you’ve checked if they are in your insurance network. Check with your insurer to determine what services related to pregnancy and delivery are covered. You should know about basic services like prenatal testing and special offers such as acupuncture to treat morning sickness. Aetna’s Member Payment Estimator allows you to compare the costs of vaginal birth versus c-section. It may seem far off, but if you plan to breastfeed, now’s the time to look into breastfeeding-related benefits such as coverage for breast pump purchases and lactation consultant services.
4. When Should I Inform My Insurance Company About My Pregnancy?
It’s not necessary to inform your insurer immediately that you are pregnant… but it is worth doing when you’re ready. Insurance companies provide pregnant women with free resources (learn about them below) that can help you prepare for motherhood and take care of yourself. You’ll need to inform your insurance company of the birth of your child if you want your baby’s medical expenses covered. Aetna’s plans cover newborns automatically for the first 30 days following birth. You’ll need your benefits administrator to officially add your newborn.
5. What Other Resources are Available Through My Plan for Me?
You can get free and helpful resources from your health insurance provider. Aetna’s Starting Right Maternity program provides information about everything from dental care during pregnancy to preparing fathers for a new baby. The nurse case manager assigned to women with specific risks during pregnancy will monitor these risks. Smokers are encouraged to enroll in a special smoking cessation program for mothers-to-be. Text4Baby is a service that provides three texts a week, each with a baby care tip. The March of Dimes also has a website full of valuable information about prenatal and postpartum health.
What Happens at a Preconception Consultation?
“The first appointment is your chance to be heard, and ask questions, DO, a family physician with Banner Health. We discuss your medical history to create a healthcare plan that is tailored to your needs.
This is the ideal time to ask all of your questions. Here are some questions you might want to ask during your one-on-one appointment, along with your ones.
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1. What Lifestyle Changes Should I Make Before Becoming Pregnant?
You will most likely receive a physical examination, and your provider may suggest that you undergo pre-pregnancy testing, such as urine or blood tests.
You may discuss your weight, diet, medical history, and lifestyle changes during this appointment to increase your chances of conception. The importance of limiting coffee, quitting smoking/nicotine and marijuana, as well as avoiding illicit substances.
Other steps include:
- Maintaining a healthy weight and a balanced diet: Being overweight or underweight can decrease fertility, and cause pregnancy complications such as gestational diabetes, hypertension, and miscarriage.
- Regular exercise can improve fertility.
- Relaxing and reducing stress: Stress can’t be the cause of infertility, but it can impact your health and well-being. Take part in activities that reduce stress, such as yoga and deep breathing. Consider speaking to a licensed mental health specialist if stress overwhelms you.
2. When Should I Stop Taking Birth Control or Other Medications?
Some people will experience ovulation within a couple of weeks of stopping birth control. Some hormonal methods, such as NuvaRing and birth control pills, can affect your cycle over a few weeks. Discuss with your provider when you should remove an IUD if you have one.
Some over-the-counter (OTC), and prescription medications may also interfere with your ability to become pregnant. Speak to your doctor about any safety concerns. They may adjust your medication or recommend that you avoid certain herbal supplements and vitamins to ensure a healthy pregnancy.
3. When Should I Begin Taking Prenatal Vitamins?
Begin taking prenatal vitamins two months before trying to conceive.
Folic Acid is an important nutrient during early pregnancy. It is also helpful in reducing the risk of neural tube defects and certain birth defects.
