Health Insurance and Pregnancy: What’s Covered and What’s Not

Okay, so I am officially 13 weeks pregnant and after the excitement, I feel like first trimester is so much of like, oh my god, I'm in shock, I'm in denial, this is happening. Okay, my stomach is starting to feel nauseous. Okay, I have to set appointments, there's so much going on. So after that initial excitement, I was like, health insurance, how does that factor in to bringing a baby into this world? What do they cover? What don't they cover? I'm gonna go over that in this video. Hey guys, welcome back. It's Justine with Debt-Free Millennials, the channel to help you crush your debt and live payment-free. I mentioned I'm 13 weeks pregnant. If you didn't catch my pregnancy announcement video, I will link to that in the description box below. But one of the things that I was thinking about when I first found out about the new baby, I was like, how much is this gonna cost? So health insurance in the States is a big mess. Yes, Canada, we know. However, if you have the right tools and resources in front of you from the get-go of your pregnancy, it can really help alleviate some of the stress. So the best tool that I've been using is an insurance questionnaire, a whole list, inside of the Budgeting for Baby course by Marissa Leida. I freaking love this course. I went through this course as soon as it came out. And I have to tell you, I'm living and swearing by this workbook because Marissa has a whole section on insurance and she has great prompts and a whole questionnaire of what to ask your insurance company to figure out exactly what they cover and don't cover during your pregnancy. If you're interested in this course, I will link to my affiliate link below so that you can purchase it as well and walk through it. Super simple, you get the workbook with it too. It's so awesome. Okay, so one of the first things that I did with my health insurance is I wanted to figure out what my deductible was and then what exactly they cover for pregnancy visits. Now, I'm on a high-deductible health plan with a health savings account. If you don't know what a health savings account is, I will link to a whole video where I explain exactly how they work in the description box below. But our premiums are a lot lower. Kyle and I pay $400 a month for our health insurance for two of us. So that's $200 for my complete health insurance per month and $200 for Kyle. So HDHP with the HSA. Do not treat pregnancy in a way that I think they should treat pregnancy. So what I initially found out on my health insurance platform is that they said all prenatal appointments are covered 100%. There's no deductible, you don't have to pay anything. Cool. So in my head, that would cover ultrasounds and any medically necessary laboratory results. So when you first become pregnant, they'll have you do a blood draw pretty early on and they will test you for things like HIV, tuberculosis, measles, rubella, like literally 10 to 12 different diseases. And to me, that feels preventative. And I found out later on that insurance, my insurance does not cover lab tests and they do not cover ultrasounds, which I find extremely bizarre, but that is the case for my insurance, which is a high deductible health plan with the health savings account. Now, because they don't cover those things, that cost gets passed on to me. It goes towards my deductible. And so I found this out. My individual deductible is $2,800. Kyle and I together is $3,600. So once I meet $2,800 out of pocket, then my insurance switches over to this co-pay where they'll pay 85% of the cost and then I pay 15. Now, when I started getting these lab tests in and I was seeing $300 here, $200 there, it kind of raised some red flags for me because I thought all of that was included in my prenatal appointments. But when I spoke to my health insurance, they said that is not the case. And I actually went through the whole PDF of my coverage and it does clearly state exactly what is and isn't covered. So if you are using Marissa's questionnaire in her insurance prompt, you're gonna know to ask how much your deductible is and then how co-pays work with your prenatal appointments. Another thing that she had in her workbook that I loved, I didn't even know you could ask this, is to provide a cost estimate of delivery at your hospital. And so I asked that question to my insurance company. Of course, they couldn't pull it up because in their mind, they're like, well, the claim has to be submitted first. So they couldn't give me an estimate on that. But I did find out that my plan covers 100% for a breast pump and supplies and six free lactation visits. So that was really good news. Another thing that my insurance does not cover when it comes to pregnancy and delivery is they will cover the cost of delivery, but they won't cover the cost of anesthesia, aka epidural. So if I choose to get an epidural, then that cost is going to be additional and that will be billed to my insurance and then I'll likely have a co-pay. But at that point, I'll probably hit my deductible and then the co-pay would be 15%. All this to be said, we have a health savings account that we maxed out purposely at the beginning of this year for baby. So we have plenty of money in that account to cover expenses like this. It does make me question whether or not we're on the right health insurance plan. So whenever you're in open enrollment period, please compare the insurance plans and make sure they fit exactly what works best for you. I love having the health savings account. However, we may find that with having a baby, we could be better off on another insurance plan. Although, I'm not sure if I can change insurance plans even during an open enrollment period while I'm pregnant. So I'll have to figure that out and let you know. Okay, so all of this information correlates to my high deductible health plan with a health savings account. Regardless of whatever health insurance plan you're on, the most important things you can do when you find out that you're pregnant is to ask your health insurance provider what your deductible is, what they cover for pregnancy appointments. Even though they say 100% prenatal appointments, does that truly cover blood work, lab tests, urine tests? Does it cover ultrasounds? Because in my case, it didn't cover ultrasounds. It didn't cover the blood draw. So you'll want to find that out. And then you'll want to know if they can provide a cost estimate of delivery at your specific hospital and whether or not they cover things like lactation visits or breast pump and supplies. Those are really helpful things to know right away so that you can make plans for that in the future. I'd love to know what your experience has been like working with a health insurance provider, or if you just found out that you're pregnant, do these prompts and questions help you? If you want more helpful tips on how to navigate budgeting for baby, bringing a debt-free baby into this world, I highly recommend you check out Marissa's course, Budgeting for Baby. I will link to my affiliate link in the description box below. If you like these types of videos where we're talking about debt-free babies and budgeting for them and not going into debt while you're pregnant, hit the like button. Let me know in the comments below if you wanna see more content like this, and I'll catch you guys in the next video.