Why are there waiting periods for maternity with private insurance?

This subject again deals with perception versus fact.   In the employer sponsored healthcare market, maternity is never a preexisting condition.  If you never had insurance in your life, and got a job with benefits, and you were 8 ½ months pregnant, you could not be turned down, and your childbirth expenses would be covered.  In the individual plan market, if you or your husband were expecting a child, you would be declined.   Even if you are not pregnant and we approved for medical coverage with optional maternity benefits, you would most likely be subject to a waiting period for benefits to begin.   The benefit can be on a scheduled or limited benefit period, a waiting period for conception, or no coverage until a certain amount of time has passed.     Many individual carriers offer no coverage at all for maternity.   Even with all these limitations the cost for the optional benefit is very expensive.

 

Those that are likely to buy coverage for maternity are generally actively trying to have children.  The great majority of people that buy this coverage will be successful in conceiving a child, and thus the cost for insurance is prepaying for a successful outcome, plus the insurance company takes on a series of risks that can be cost prohibitive.   Aside from complications like a C-section at delivery, there are the unspoken risks and costs associated with multiple births, preemie deliveries, or other significant issues that can cost an insurer well into the six figures.  It’s not the delivery expenses that an insurer is trying to avoid; it’s the unexpected six figure expense as well as being responsible for children with congenital issues.  To dis-incent you from choosing them as a carrier, carriers make maternity benefits a prohibitive purchase. 

 

Both of the Presidential candidates have talked a big game about healthcare changes, but no “Hillary-type” plan is in the works.  Unfortunately, the only way that all of us will save on healthcare, is if every American is required to have s

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