Maternity Coverage

None of the individual and family plans we usually recommend covers maternity.  There are only two companies that has some maternity coverage as an option and that is Golden Rule and Humana.  For an extra $106 per month Golden Rule will give you a lifetime maximum of $4,000 for maternity coverage.  For the first year you will only receive 50% or $2,000.  If you are currently pregnant they will not take you.  Their base rate without the maternity rider is much higher than the most competitive companies.  If you select the maternity rider, they assume you will get pregnant within a year, and they make sure that you will pay more than they have to pay out in claims.  It is a business; they have to make a profit on you.

Humana's maternity rider has a seperate $500 deductible and Humana will cover 75% of the cost after the deductible.  The cost for this rider varies depending on which county you live in but the average cost is $300 extra per month.  This rider can only be added to a new policy and you can not be currently pregnant.  If you are planning on getting pregnant within a few months this option might be cost effective for you.  Please call us for a thorough analysis of your personal situation to see if this plan will be right for you.

Should maternity be covered in Texas?  Well it is debatable - the real question is WHO PAYS FOR IT?   If everyone's policy covered maternity what would this do to the health insurance rates?  Would they go up by 30%, 40%, 50%???  I don't know... but with Texas having one of the highest uninsured populations in the United States - adding an expensive feature such as maternity to cover on a select few that are effected doesn't seem like it would benefit the state population as a whole.

What if I am currently pregnant?
You and anyone in your household except existing children are NOT eligible for individual health insurance.  Try to get on a group health insurance plan, contact the state risk pool, or your local health department.

How do you buy a plan with maternity in Texas?
Generally the only plans that cover maternity are GROUP plans, meaning plans you obtain from work.  If you are self employed and have a 'real' company (meaning you pay taxes, legally formed, have at least one employee) we can look at some GROUP options (although not always affordable).

Why doesn't Individual Health Insurance Cover Maternity?
The short answer is maternity coverage is NOT profitable.  I will say that one more time, it is NOT profitable.  This is a good time to remind everyone that Health Insurance is private in the United States.  Most Individual Health Insurance plans for single females range from $70 - $150 - with most people making selections around $100/mo. 

Example #1 - Why Maternity Is Not Covered....
$100 per month Health Insurance = $1200 / per year.  This is to cover all risk associated with your health.  Over 5 years you will pay the incredibly low amount of $6000 - now when you throw in the likelihood of you having a baby in those 5 years - the Health Insurance company is almost guaranteed to lose money by covering your maternity expenses!!! 

Suggestions and Options:
Now that you understand WHY maternity is not covered - let me offer some suggestions on how you can deal with the situation of maternity health insurance in Texas:

ý        Stop searching the internet looking for something that does not exist.  Expecting an insurance company to subsidize your lifestyle is not a reasonable request.  Be realistic about this situation and listen to what I have to say - it could save you TIME and MONEY. 

ý        If you are currently pregnant
Try to get on a group plan or contact the State High Risk Pool.  Remember the cost of your pregnancy will be anywhere from around $3,500 with deep discounts upwards to several hundred thousand with complications.

• Buy a plan with no maternity - Yes you are going to hear this over and over again - so get used to it :-)  Any plan on our site will suit you just fine - if you get pregnant get on an employer group plan, or negotiate a maternity package with your doctors and hospitals.  Sure it is going to cost you thousands of dollars - but someone has to pay for it :-)
• Buy a HSA compatible health plan (best option) - These plans do NOT cover maternity either.  However they DO allow you to setup a savings account and you can save apx. $2600 (single) or $5150 (family) into a TAX FREE savings account.  Why would you do this?  If you negotiate a maternity package with your doctors and hospital do you want to pay for it with PRE-TAX or AFTER-TAX dollars?  This can reduce your overall costs by 25-35% depending on your tax bracket.  This plan is NOT for everyone.  If you can not, or do not want to save $2600 (single) or $5150 (family) PER YEAR into a special savings account than I wouldn't even consider this plan.  This plan requires a level of discipline and financial means to make it a success.