California Maternity Health Insurance
Lowest California Maternity Health Insurance Prices Anywhere
If you are currently pregnant, DO NOT APPLY for health insurance. Read the article below, titled “Maternity Health Insurance for the Pregnant: Is It Possible?“.
- List of California Maternity Health Insurance Plans
- Best California Maternity Health Insurance Plans
- Analysis of Best California Maternity Health Insurance Plans
- Maternity Health Insurance for the Pregnant: Is It Possible?
List of California Maternity Health Insurance Plans
Here are the health insurance plans with maternity coverage that are offered in California. This list is sorted alphabetically by health insurance company, and shows if the plan is an HMO or a PPO. This list is offered solely for use in finding the maternity plans in a maternity health insurance quote.
| Maternity Plan Name | Plan Type (HMO/PPO) |
| Anthem Blue Cross Lumenos HSA 5000 | PPO |
| Anthem Blue Cross PPO Share 3500 | PPO |
| Anthem Blue Cross PPO Share 5000 | PPO |
| Anthem Blue Cross PPO Share 7500 | PPO |
| Anthem Blue Cross Select HMO | HMO |
| Anthem Blue Cross Saver HMO | HMO |
| Anthem Blue Cross HMO | HMO |
| Blue Shield Spectrum 5000 | PPO |
| Blue Shield PPO Plan 5500 | PPO |
| Blue Shield HMO Access + Value | HMO |
| Blue Shield HMO Access + | HMO |
| Health Net HMO 40 NG | HMO |
| Kaiser 0/5000 HSA Deductible | HMO(like PPO) |
| Kaiser 30/2700 HSA Deductible | HMO(like PPO) |
| Kaiser 0/2700 HSA Deductible | HMO(like PPO) |
| Kaiser 0/1500 HSA Deductible | HMO(like PPO) |
| Kaiser 40/2000 Deductible | HMO(like PPO) |
| Kaiser 30/1500 Deductible | HMO(like PPO) |
| Kaiser 25/1000 Deductible | HMO(like PPO) |
| Kaiser 20/500 Deductible | HMO(like PPO) |
| Kaiser $50 Copayment | HMO |
| Kaiser $40 Copayment | HMO |
| Kaiser $25 Copayment | HMO |
The Kaiser “Deductible” plans are HMO plans in that you have a primary care physician that will refer you to any specialists you need to see, however, the plan benefits are structured to look like a traditional PPO with a deductible and an out of pocket maximum. For more details on what these PPO terms mean see the article 4 Keys To Understanding Insurance Plans on the “Health Insurance Quote Information” page of the website.
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Updated on October 3, 2011
Best California Maternity Health Insurance Plans
Congratulations on your decision to start a family! There are a few planning steps you’ll want to make sure you complete before you become pregnant. The first step is making sure that your finances can support the addition of a new baby. The second step is to make sure you are ready for the hardship and joy of bringing a new baby into the world. The last step is to make sure you have a good California Maternity Health Insurance plan that will help manage and reduce the financial costs of pregnancy and delivery.
It’s not uncommon for a standard pregnancy and delivery to cost between $13,000 to $20,000. The main cost is for the delivery, which in San Diego County averages between $7,700 to $13,100, depending upon the hospital. The next largest cost is for the 12-14 prenatal office visits that are recommended to check on the health of the baby and mother during the pregnancy (1/mo during 1st 6 months, 2/mo during months 7 & 8, and weekly during the 9th month). The average cost of these office visits are about $100-$200/visit. Other tests, such as amniocentesis (~$1,500 – $2,000 cost), blood and urine tests, ultrasound (~$550) all add to the total overall costs. Therefore, having health insurance with maternity coverage to help reduce these out of pocket expenses is important.
Right from the beginning, you’ll want a maternity health insurance plan that will help you reduce the costs of your pregnancy and delivery, so the following are the key benefits to look for in a good California Maternity Health Insurance plan:
1. Office Visits covered by a copay
Prenatal care is not considered preventive and therefore unless your PPO plan offers unlimited office visits, these costs are part of your PPO deductible costs.
2. Lower Deductible Amount
The deductible will come into play for your lab tests and the delivery costs, so having a lower deductible can help to reduce your out of pocket costs.
3. Lower Out Of Pocket Maximum(OOPM)
Once you reach the OOPM, the California maternity health insurance company pays for all additional expenses, so for PPO plans you’ll want this to be as low as possible.
4. Premium Cost of the California Maternity Health Insurance Plan
For items 1,2,and 3 above, the premium cost of the health insurance plan will be higher as you increase the number of offices visits allowed, or lower the deductible and OOPM amounts. So there is a tradeoff between paying more in premiums for the insurance plan versus paying for more of the maternity costs out of your own pocket.
Now for the hard part. In California there are a limited number of health insurance plans with maternity coverage to choose between. In fact some insurance companies don’t offer any maternity coverage plans (Aetna, Cigna, Celtic, CA Farm Bureau). This leaves us with Anthem Blue Cross, Blue Shield, Health Net, and Kaiser Permanente, for a total of 23 plans that provide maternity care.
When you compare all the maternity plans based upon the 4 criteria listed above, you get the following plans typically being the best options with some variations depending upon the age of the mother-to-be: (see the Health Insurance Plan Recommendation Table)
Kaiser 0/1500 HSA Deductible
Kaiser $50 Copayment HMO
Anthem Blue Cross Select HMO*
Health Net HMO 40 NG
Blue Shield Spectrum 5000 PPO
As you can see from the list above, HMO plans are a good fit for maternity care because most benefits are a co-payment, most of the time there is no deductible, and if there is a deductible in the HMO plan it is usually smaller than the deductibles in the PPO plans that provide maternity care. When you combine the cost of the California Maternity Health Insurance plan premiums with the out of pocket expenses incurred during a normal pregnancy, these plans have the lowest overall cost while providing the best care a new mother could want.
Check below to see the analysis behind these recommendations!
Many people have very black and white perspectives on Kaiser Permanente. They either love Kaiser or they hate Kaiser. So seeing Kaiser at the top of the list may be a disappointment to some, but the Kaiser plans can cut your out of pocket costs by 35% – 50% in comparison to the best plans from Health Net, Blue Cross, and Blue Shield.
What I recommend is that you sign up for Kaiser’s 0/1500 HSA PPO plan, and then about 6-9 months after the baby is born, look at getting non-maternity health insurance from another company for you and the baby. You will save thousands of dollars by doing this (for a 30 year old woman the cost savings of having the Kaiser plan versus the Health Net HMO 40 plan is $3254). It’s hard to ignore a cost difference that large.
Finding a good California Maternity Health Insurance plan can be a difficult process because the choices are limited, the information is scattered and hard to find, and there are tradeoffs between the cost of the insurance plan and the out of pocket costs for the maternity care and delivery. Here we have simplified the process by summarizing the best options for maternity care, so go ahead and get a maternity health insurance quote to see which plan is best for you.
* – The Blue Cross Select HMO uses a smaller network of physicians than the other Blue Cross HMO plans, so you need to verify that your doctor is in the “Select” network.
Stop by later to read upcoming posts about how to reduce your maternity costs!
Updated on December 15, 2011
Analysis of Best California Maternity Health Insurance Plans
As we showed above, the two best maternity health insurance plans are from Kaiser Permanente, followed by plans from Blue Cross, Health Net, and then Blue Shield. This order was determined by looking at all the out of pocket costs for a typical woman in each of the plans and picking the plans that had the smallest total cost.
The analysis of each plan is outlined below:
Kaiser 0/1500 HSA
| 14 prenatal office visits X $0/visit = | $0 + |
| 14 prenatal office visit labs X $100/lab = | $1400 + |
| Amniocentesis $100 (last of deductible) + $50/test = | $150 + |
| {at this point the plan’s $1500 deductible has been met} | |
| Ultrasound test X $50/test = | $50 + |
| Hospital Copay $300/day for 2 days = | $600 + |
| Hospital Co Insurance 0% = | $0 + |
| Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] | $2200 |
| 12 X Monthly Premium of $204 = | $2448 + |
| (Total Before Tax Cost) | $4728 |
| Using a HSA to get 15% tax savings on the out of pocket costs ($2200 X 15%) = | $330 - |
| For a Total Out of Pocket Cost of | $4318 |
Kaiser 50 Copaymant
| 14 prenatal office visits X $40/visit = | $0 + |
| 14 prenatal office visit labs X $10/lab = | $140 + |
| Amniocentesis X $50/test = | $50 + |
| Ultrasound test X $50/test = | $50 + |
| Hospital Copay $500/day for 2 days = | $1000 + |
| Hospital Co Insurance 0% = | $0 + |
| Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] | $1240 |
| 12 X Monthly Premium of $267 = | $3204 + |
| Total Out Of Pocket Cost | $4444 |
Blue Cross Select HMO*
| 14 prenatal office visits X $25/visit = | $350 + |
| 14 prenatal office visit labs X $0/lab = | $0 + |
| Amniocentesis X $0/test = | $0 + |
| Ultrasound test X $0/test = | $0 + |
| Hospital Copay $250/day for 2 days= | $500 + |
| Hospital Co Insurance 0% = | $0 + |
| Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] | $850 |
| 12 X Monthly Premium of $574 = | $6888 + |
| Total Out Of Pocket Cost | $7738 |
Health Net HMO 40
| 14 prenatal office visits X $40/visit = | $560 + |
| 14 prenatal office visit labs X $0/lab = | $0 + |
| Amniocentesis X $0/test = | $0 + |
| Ultrasound test X $0/test = | $0 + |
| Hospital Copay $1500 deductible = | $1500 + |
| Hospital Co Insurance 0% = | $0 + |
| Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] | $2060 |
| 12 X Monthly Premium of $465 = | $5580 + |
| Total Out Of Pocket Cost | $7640 |
Blue Shield Spectrum 5000 PPO
| 14 prenatal office visits X $150/visit = | $2100 + |
| 14 prenatal office visit labs X $100/lab | $1400 + |
| Amniocentesis X $1000/test = | $1000 + |
| Ultrasound test X $550/test = | $500 + |
| {at this point the plan’s $5000 deductible has been met} | |
| Hospital Copay $0 = | $0 + |
| Hospital Co Insurance 30% of $10k = | $2990 + |
| {at this point the plan’s $7000 max out of pocket has been met} | |
| Total PreNatal and Delivery Out Of Pocket Costs = [sum of above costs] | $7000 |
| 12 X Monthly Premium of $157 = | $1884 + |
| Total Out Of Pocket Cost | $8884 |
The assumptions for the above calculations are that the maternity insurance California plan lasts 1 year and that the mother becomes pregnant and delivers the baby in that 1 year period. The total hospital costs for the vaginal delivery are expected to be $10,000, with a 2 day hospital stay, and the mother goes through the typical 14 prenatal office visits and various blood and urine tests during each office visit. The premium costs are for a 30 year old woman in San Diego county for an December 1st, 2011 effective start date.
An interesting observation from the analysis is that even though the Kaiser 0/1500 HSA plan has higher out of pocket costs for the prenatal care and delivery in comparison to many of the other HMO plans, the cost savings from the lower monthly premiums and from the tax savings, enables it to have the lowest total out of pocket costs. Without the tax savings from the HSA account, the Kaiser 0/1500 HSA plan would have been 2nd behind the Kaiser 50 Copaymanet plan.
The second observation is that plans with the lowest monthly premiums, aren’t usually the best in lowering your total out of pocket costs during the pregnancy and delivery (the Blue Shield Spectrum 5000 PPO plan has the lowest monthly premium, but is 5th best). However, plans that minimize the prenatal and delivery out of pocket costs also aren’t the best options (the Blue Cross Select HMO plan has the smallest out of pocket costs, but is 3rd best). It’s the combination of the premium costs and the out of pocket costs that determines which plan will result in the lowest total out of pocket cost.
Using the outline above, a couple can determine what they should expect to pay out of pocket for any of the California maternity health insurance plans. The plans highlighted in this analysis are the five having the lowest total out of pocket costs, with the best option being chosen from each of the insurance companies that offer maternity coverage (Kaiser offers several plans that are lower cost than the other insurance companies but only the 2 best Kaiser plans are shown).
Ultimately, the best maternity insurance plan is the one that provides quality of care while reducing your total out of pocket costs. To determine this you need to consider both the premium cost of the pregnancy insurance plan as well as the expected out of pocket costs. This way you can get the right combination of quality care and cost.
For more information on HSA plans and their tax-free savings accounts, stop back to see an upcoming article.
California Maternity Health Insurance for the Pregnant: Is It Possible?
The short answer is probably not, unless you qualify for one of three insurance options, or a state provided assistance program. The reason is that the insurance companies view being pregnant as a “Pre-existing Condition,” the costs associated with normal pre-natal and delivery care are much higher than the combined monthly premiums for a maternity health insurance plan, and if there are any complications then the costs quickly climb at an exponential rate (a premature baby can have over $30,000 – $85,000 in medical costs in the first few weeks, and premature birth affects more than 1 in 10 California babies). Health insurance companies therefore will decline an application from a woman that is pregnant at the time of the application. So the mother to be needs to explore other alternative strategies to get maternity coverage.
The first alternative is to join a group health insurance plan at the company you work for or your spouse’s company. Almost all group health insurance plans offer maternity coverage. This is not an a slam-dunk however, because group health insurance plans have open enrollment periods during which employees and dependents can be added to the company health insurance plan. If your pregnancy occurs within a few months of the open enrollment period, then you can use this option and simply pay for the cost of the early prenatal visits out of pocket, until you are on the group plan.
Stop by a later to read a post on how to create your own group health insurance plan so you can get health insurance regardless of what pre-existing conditions you have.
The second alternative is for women that have a private or individual health insurance plan that does not offer maternity care. In this situation you should ask the insurance company if they will allow you to transfer to a plan that offers maternity coverage. In California, Blue Shield will allow this type of transfer, but the other medical insurance companies will not.
The third alternative is to apply for the California Pre-Existing Condition Insurance Plan (PCIP California) that was created by Health Care Reform. To qualify for this plan you must have been un-insured for at least 6 months, and have been declined by a health insurance company. This plan will provide coverage for pre-natal care and delivery costs, and the premium cost will be about the same as a private HMO plan that covers maternity care.
If the above options don’t help you, there are a couple of non-insurance options. Depending upon what state you live in, there are government programs to provide assistance and care for pregnant mothers to be, so check with your State Department of Insurance to determine what your local options are. In California, there is the state Medi-cal program (Medi-cal is the California version of Medicaid), and the Access for Infants and Mothers (AIM) program.
If you are pregnant and don’t have health insurance, then you should start with Medi-cal first to see if you qualify for coverage through their program. Medi-cal provides a zero-cost health plan for pregnant women that meet specific income limits. Medi-cal is intended to cover families and women that are below the federal poverty level. If you don’t qualify for Medi-cal then apply to the AIM program.
The AIM Program is low-cost health care coverage for pregnant women, and is provided for middle-income families who don’t have health insurance and whose income is too high for no-cost Medi-cal. AIM is also available to women who have private health insurance plans with a maternity-only deductible or co-payment greater than $500. To be eligible for AIM a single mother’s monthly household income must be between $2,453 to $3,679 (there is a table with income ranges for families with other children at http://www.aim.ca.gov/Costs/Income_Guidelines.aspx). The AIM program is funded by the State of California, and although funding is usually available, if the program is filled up, then no additional mothers will be enrolled.
Although maternity health insurance is not usually available after you become pregnant, there are options that can provide insurance coverage and non-insurance assistance. Joining a group health insurance plan through your company or your spouse’s company, transferring to a plan that offers maternity coverage, or applying for the PCP plan are your insurance options. The Medi-cal and AIM programs are non-insurance assistance options that are designed to provide maternity care to the uninsured mother. With these five choices there should be a solution for all mothers to be.
For additional information about AIM and Medi-cal see the following websites:
http://www.aim.ca.gov/AIM_Program/ Information about the AIM program
http://www.dhcs.ca.gov/services/medi-cal/Pages/MCIndividual.aspx Information about Medi-cal
http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_women.aspx Information about the Presumptive Eligibility program to gain access to Medi-cal.
More articles on California Maternity Health Insurance coming soon
Resource Links for Maternity Information
Lowest California Maternity Health Insurance Prices Anywhere
The Department of Insurance regulates California maternity health insurance premiums. It doesn’t matter if you go directly to the insurance company, or apply with SPF Insurance, you get the same low price wherever you go. Working with SPF to get maternity insurance California citizens will find the information and help they need to simplify the process so it’s fast and easy.
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Thanks Morice. Let me know if there’s anything more you’d like to see.
Very helpful post man, thanks for the info.
I was very excited to find this comparison of plans with maternity coverage, especially with the specific cost breakdown. I had already figured out that Kaiser is probably best for me, but I’ve been trying to choose between the plans. However, there are two things that I’m confused about. First, according to Kaiser’s brochures and info given me by one of their sales reps (Dec. 2011), routine scheduled prenatal visits ARE covered at no charge on all of the Kaiser health plans that include maternity. Second, you show the office visit copay as $40 for Kaiser 50 Copayment when Kaiser brochures list it at $50. The latter is relatively minor, but the former is extremely huge since it impacts how to calculate deductible/OOP expenses. for the different plans. Can you provide any clarification of this discrepancy? Thank you.
Mandy,
Thank you for visiting the website. I reviewed your questions and realized that we had overlooked the fact that Kaiser includes the pre-natal visits at zero cost in the analysis (none of the other carriers do that). The lab tests for the pre-natal visits will still be part of the deductible for the HSA plans, and a copay for the Copayment plans. I will update the website tomorrow with the new results. The $40 vs $50 copay is a typo we missed (It was copied from the $40 Copay plan to the $50 Copay plan)..
Oops!
Tim