Open enrollment tips for choosing a health plan to cover maternity

Epidurals and ultrasounds can be sources of unexpected financial headaches for growing families, according to a local expert on health insurance plans that cover maternity.

“You want to make sure that you have full maternity coverage for one thing,” said Dr. Heather L. Johnson, a senior partner at Advantia Health practice Reiter, Hill & Johnson.

“And that’s not just for the pregnancy itself, but also for the delivery, which is generally the most expensive part of it,” she said.

Whether you explore HMO (health maintenance organization) or PPO (preferred provider organization) options may depend on where you are in life.

“If you’re fresh out of college and still with lots of loans and really don’t want anything unexpected, then you might want to go with an HMO,” Johnson said. “Everything’s covered. You have to go to their chosen doctors, but everything’s covered.”

But, if you want to choose your own doctor or have a preferred hospital and your household has financial flexibility, you might consider a PPO.

Particulars to look out for include copays, deductibles, what you’re expected to pay out of pocket and the percentage that gets paid.

Also, find out about epidurals. Sometimes a hospital that takes your coverage might contract with anesthesiologists or have an anesthesia department that doesn’t accept your coverage.

“So, you get your epidural and later get a bill for it,” Johnson said.

Bills that often come as a surprise to patients involve ultrasounds. Most insurance companies will cover an initial ultrasound, and one at 20 weeks, but Johnson said some won’t cover any beyond that.

“Or, they’ll cover them at a certain cost and you think that it’s $500 and it’s actually $700,” she said.

Midwives and doulas are becoming increasingly popular and Johnson said you might be able to help pay for them through your flexible spending account.

“If those are of importance to you, then that is certainly something you should look into,” Johnson said.

Kristi King

Kristi King is a veteran reporter who has been working in the WTOP newsroom since 1990. She covers everything from breaking news to consumer concerns and the latest medical developments.

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