Planning for a baby brings excitement and a long to-do list. In the United States it also brings an uncomfortable question: how much is the delivery going to cost us? This guide is about settling that part early, so it doesn't steal the joy from the rest.
If you're already pregnant, this policy will not cover this delivery. Maternity counts as a pre-existing condition. I'm telling you in the first paragraph instead of the last, because it's what decides whether this is useful to you at all.
What having a baby costs, even with insurance
Having health insurance — from the Marketplace or from work — doesn't mean the delivery is free. Between the deductible, copays and the days in hospital, money comes out of your pocket. This is what I see in practice with my clients:
| Situation | What usually comes out of your pocket |
|---|---|
| Vaginal delivery | Between $3,000 and $8,000, depending on your plan's deductible. |
| C-section | Can go over $10,000: it means more days admitted. |
| The weeks you don't work | No health insurance covers this. And it's what squeezes hardest. |
Look at the third row, because it's the one almost nobody adds up. Your health insurance pays the hospital and the doctors. It doesn't pay you. If you take weeks or months of unpaid leave, you cover that gap yourself.
How the cash payment works
A hospital indemnity policy is a supplemental product. It doesn't replace your health insurance and it doesn't pay the hospital: it pays you, in cash, for having been admitted.
This policy is issued by Washington National, and their condition for paying the maternity benefit is that you spend a minimum of 24 hours in hospital after the birth. If the admission doesn't reach those 24 hours, the payment isn't triggered. I'm spelling it out because it's the requirement everything else depends on.
In practice it's met without you having to do anything special: a typical stay after a birth in the U.S. — vaginal or by C-section — goes beyond those 24 hours. But it's the hospital that records your admission and discharge, so always ask for your hospital discharge summary: that piece of paper is what proves the hours.
| How it works | What it means |
|---|---|
| What triggers the benefit | A minimum of 24 hours admitted to hospital after the birth. |
| Whether that's met | Yes. For both vaginal delivery and C-section, the usual stay in the U.S. goes past 24 hours. The requirement is met on its own. |
| Who receives the money | You. It goes to your account, not to the hospital. |
| How much | A fixed amount written into your policy, of up to $10,000 depending on the coverage designed. It isn't an automatic figure: it depends on the plan you buy. |
| What you spend it on | Whatever you decide: the deductible, things for the baby, or rent while you recover. |
The two conditions. No fine print
This benefit has two rules you have to meet, and I'd rather you know them now than when you file the claim.
1. You cannot be pregnant when you apply for the policy. If you already are, that pregnancy counts as a pre-existing condition and the delivery isn't covered. There's no way around this one.
2. There's a waiting period. The policy has to have been active for a while before the birth — in these plans it's usually nine to ten months from the issue date. The exact number is written in your policy, and that's the one that governs.
Activate the policy and wait 30 to 60 days before trying to conceive. With nine months of pregnancy ahead, that leaves plenty of room over the waiting period. If you conceive before it's complete, the delivery isn't covered — and that margin is exactly what keeps you from falling short by a few weeks.
About your immigration status
This policy does not go through the Health Marketplace. It's a private product, so the immigration status requirement Obamacare applies for the tax credit doesn't apply here.
As with any insurance, issuance is subject to the insurer's approval. If that's your question, write to me and we'll go through your specific case, confidentially and without judgment — the same as I do with Marketplace enrollment.
The plan, phase by phase
Before trying to conceive. Review the deductible on your current health plan. Design the hospital policy with me. Activate it. And wait the 30 to 60 days.
During the pregnancy. Your prenatal checkups go through your usual health insurance. Keep the paperwork and the hospital admission records.
When you give birth. Complete the 24 hours of stay, ask for the hospital discharge summary, and file the claim. I'm with you for that part: it's the same one I explain in what to do if you're denied something.
And if you're already pregnant
Then this policy isn't for this baby, and I'm not going to sell you otherwise. What we can do is review your Marketplace plan: what deductible you have, whether there's a better option for your case, and whether you qualify for more help than you're getting. That does change the numbers this year.
And if you're self-employed, look at what happens to your income during leave too: I break it down by trade in cleaning, beauty y construction.
Are you planning to have a baby in the coming months?
That's exactly the moment to talk. We design the plan early and with no obligation. Free of charge, in your language.
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Sources
This guide is educational and informational and does not constitute an insurance contract. The supplemental hospital policy is issued by Washington National Insurance Company. Benefits are subject to underwriting approval, the terms of the policy, pre-existing condition limitations and the waiting periods applicable to maternity. Benefit amounts vary by the plan purchased; the cost ranges shown above are rough estimates, not guaranteed figures. Omar Mendoza, licensed agent — NPN 21726482.