Although the federal government recently clarified that most insurance plans must cover prenatal care as a preventive service without charging women anything out of pocket, it didn’t address a crucial and much pricier gap in some young women’s coverage: labor and delivery costs.
Perhaps that shouldn’t come as a surprise.
Insurers and some employers have long tried to sidestep paying for maternity care, which includes prenatal, delivery and postpartum services. Individual plans typically refused to pay for pregnancy-related services until the Affordable Care Act established that maternity and newborn care are both essential health benefits that must be included in individual and small group coverage.
Large employers that provide health insurance are required to cover maternity care for employees and their spouses under the Pregnancy Discrimination Act of 1978. But that protection doesn’t extend to dependent children, even though under the health law, adult children can now stay on their parents’ plans until they turn 26.
In May, the federal government clarified that preconception and prenatal care is covered without cost sharing for dependent children in all plans, except for plans that were grandfathered under the law.
But prenatal care is a small portion of the cost of having a baby, and families that have to pay for an adult child’s labor and delivery charges could be on the hook for thousands of dollars.
Insurers paid $18,329 for a vaginal birth and $27,866 for a cesarean birth on average in 2010, according to a study by Truven Health Analytics. Consumers paid an average of $2,244 and $2,669, respectively, out of pocket. The payment totals include all maternity care.
Hospitalization made up between 81 and 86 percent of the total cost of pregnancy and childbirth, the study found.
“The payments that are made are highly concentrated in that little window,” says Carol Sakala, director of the Childbirth Connection, one of the organizations that commissioned the study. The Childbirth Connection is a program of the National Partnership for Women and Families, a women’s health advocacy group.
Although there’s no data on how many large employer plans refuse to cover maternity care for dependent children, benefits analysts say it’s common.
In 2013, the National Women’s Law Center filed sex discrimination complaints with the Office for Civil Rights of the Department of Health and Human Services against five employers that exclude pregnancy-related coverage for the dependent children of their employees.
The law center brought the complaints under Section 1557 of the health law, which protects people from discrimination on the basis of sex, race, color, national origin, age, disability, gender identity and sex stereotypes.
“Pregnancy discrimination is per se sex discrimination,” says Dania Palanker, senior counsel at the National Women’s Law Center. The center is still awaiting a response from the civil rights office.
The HHS Office for Civil Rights can’t comment on open cases or compliance reviews, a spokesperson there said.