Does a high deductible plan make sense for pregnancy?
Asked by: Dorothea Luettgen Sr. | Last update: November 2, 2025Score: 4.7/5 (4 votes)
Is a high deductible plan good if pregnant?
For the HDHP, maternity is 100% covered after meeting the deductible (including birth). It also depends when you get pregnant during the 12 month insurance year. For the first 2 trimesters, you have less maternity visits, but usually a round of blood work and 1 or 2 sonograms.
What type of insurance is best for pregnancy?
Health coverage if you're pregnant, plan to get pregnant, or recently gave birth. All Marketplace and Medicaid plans cover pregnancy and childbirth. This is true even if your pregnancy begins before your coverage starts.
Is it better to have a high or low deductible with a baby?
After your baby is born, you can add your newborn to your plan and switch to a less expensive plan with a higher deductible if you don't typically go to the doctor very often. Pro tip: If you qualify for a cost-sharing reduction, you can find Silver plans with low deductibles and reduced out-of-pocket maximums.
Who should not use a high deductible health plan?
A chronic illness, such as heart disease or diabetes, can be much more expensive to manage under an HDHP than a traditional health care plan. With these conditions, regular medications and health screenings may be required. These costs may quickly add up until deductibles are finally met.
When is a High Deductible Health Plan with an HSA a Good Choice?
What is the downside of a high deductible?
The primary disadvantages of a high-deductible health plan include the high out-of-pocket costs and the potential reluctance to seek medical care due to upfront expenses. While HDHPs have lower premiums, individuals may face financial strain if they need medical services before meeting the deductible.
Is it worth having a high deductible health plan?
HDHPs have higher out-of-pocket costs than LDHPs. So, this type of plan is best for healthy people who expect little to no healthcare expenses. If this outlines your scenario, the HDHP's lower premium will likely save you more money than you would spend on medical care.
Do you have to pay deductible twice for pregnancy?
The study, from the USC Schaeffer Center for Health Policy & Economics, finds that some women with high-deductible health plans pay their cost-sharing limit twice during pregnancies that occur across two health plan years, which are typically calendar years.
Is it better to have PPO or HDHP with a newborn?
In some situations, a plan with a lower deductible and higher premiums is a better choice. Consider a PPO or HMO if: You have a family with young children. You're planning to have a baby soon.
Is it better to have a $500 deductible or $1000?
Remember that filing small claims may affect how much you have to pay for insurance later. Switching from a $500 deductible to a $1,000 deductible can save as much as 20 percent on the cost of your insurance premium payments.
What can I claim when pregnant?
Statutory Maternity Leave
If you are employed and pregnant, you are entitled to 52 weeks (1 year) of maternity leave, no matter how long you've worked for your employer. This is made up of 26 weeks of ordinary maternity leave and 26 weeks of additional maternity leave.
How much is a prenatal visit without insurance?
The amount your obstetrician charges for each visit could range from about $90 to more than $500. Other services, such as ultrasounds and laboratory tests, are typically billed separately and cost upwards of $100 each. And special tests like an amniocentesis can cost more than $2,500.
When should I take pregnancy insurance?
The maternity insurance waiting period ranges from 9 to 24 months, depending on the plan. It means you can claim the policy only once the waiting period ends. None of the claims is admissible during the waiting period. So, if you want to plan a family next year, get pregnancy insurance in advance to reap its benefits.
What insurance should I get if I'm pregnant?
If you have concerns about being able to pay for insurance, options for insurance during pregnancy include Medicaid and the Children's Health Insurance Program (CHIP).
How much does HDHP childbirth cost?
Predicted prices decrease from $5702 to $5551 after HDHP switch in markets with more than three hospitals due primarily to lower prices conditional on using the same hospital.
Is birth control covered by high deductible health plan?
This now includes, but is not limited to, OTC birth control pills and emergency contraception, regardless of whether they are purchased with a prescription. HDHPs may cover these expenses before such an individual satisfies the minimum statutory HDHP deductible without affecting their HSA eligibility.
Is a high deductible plan bad for pregnancy?
Pregnant women enrolled in an HDHP might be exposed to high out-of-pocket costs, particularly when complications arise. Many HDHP policies available on the individual insurance market exclude coverage for maternity care altogether, so that expenses for these services would not even count towards the deductible.
What are the disadvantages of HDHP?
The cons of high-deductible health plans
Yes, HDHPs keep your monthly payments low. But there are some downsides you should consider, including: Large medical expenses: Since HDHPs generally only cover preventive care, an accident or emergency could result in very high out-of-pocket costs.
What is the main disadvantage of choosing a high deductible on an insurance policy?
Costly out-of-pocket medical expenses: If you choose a high-deductible health plan and need non-preventive medical care, or costly medical care, you will have to pay all of your deductible before your plan begins to help you pay for covered costs.
Do you hit out-of-pocket max when having a baby?
When you give birth, you will most likely pay at least your deductible in medical expenses for the year. Out-of-pocket max: After you've hit your deductible, your insurance will cover a set percentage or rate for services and you will be charged the balance, up to your out-of-pocket maximum.
How much is a hospital bill after having a baby with insurance?
The average cost of having a baby with insurance is $6,940, which includes the cost of labor, delivery and medical care for you and your newborn. How much you'll pay depends on your plan, the hospital you use and how you give birth.
Can you switch insurance while pregnant?
You can switch your health insurance while pregnant only during the Open Enrollment Period or if you have experienced one of the other life events listed above. Pregnancy does not qualify you for a Special Enrollment Period, but giving birth does.
Why do companies push high deductible health plans?
Although a high deductible may sound like a bad thing, in some cases, it makes financial sense. By opting for a higher deductible, employees can secure lower monthly premiums. This makes coverage more affordable, and it can be particularly appealing to young workers who do not expect to have major health issues.
What is the 12 month rule for HSA?
It means you must remain eligible for the HSA until December 31 of the following year. The only exceptions are death or disability. If you violate the testing period requirement, your ineligible contributions become taxable income.
Do you get a tax break for having a high deductible health plan?
Leverage the tax breaks.
The HSA that comes with an HDHP offers a potential triple tax advantage2, that helps you save on taxes: Your HSA contributions are made pre-tax. Interest and any investment earnings in the account are tax-free. Your payments for qualified medical expenses are tax-free.