New Study Compares Out-of-Pocket Costs for Maternity Care in High-Deductible and Traditional Health Plans

Consumer-driven health plans generally require families to pay higher out-of-pocket costs for maternity care than traditional insurance plans, according to a new study from researchers at the Kaiser Family Foundation and the Georgetown University Health Policy Institute, the Washington Post reports (Lee, Washington Post, 6/13).

The study compared 12 consumer-driven health plans with one traditional, more comprehensive plan, MarketWatch reports. Researchers established three scenarios across the health plans: an uncomplicated pregnancy with a vaginal delivery; an uncomplicated pregnancy with a caesarean section delivery; and a complicated pregnancy with gestational diabetes, preterm labor and a c-section delivery (Gerencher, MarketWatch, 6/12).

According to the report, total allowable costs for an uncomplicated pregnancy and vaginal birth would be about $9,660. Under a traditional plan, a family would have to pay about $1,455 out-of-pocket costs, while out-of-pocket costs under consumer-driven health plans would be between $3,000 and $7,884, the report found. For an uncomplicated c-section delivery, families enrolled in traditional health insurance would have out-of-pocket costs of $2,244 out of total allowable costs of $12,453, according to the report. In comparison, consumer-driven health plans would require families to pay $3,545 to $9,818 in out-of-pocket costs (Carey, CQ HealthBeat, 6/12).

Out-of-pocket costs for a complicated pregnancy, which would require intensive treatment, under a traditional plan are about $8,770 of the estimated $287,453 allowable cost, according to the report. Under consumer-driven plans, families would be required to pay between $6,000 and $21,194 out of pocket (MarketWatch, 6/12).

Reaction
"This is an issue that consumers struggle with from time to time with health insurance regardless of what kind of plan you have," Karen Pollitz, co-author of the report and a research professor at Georgetown, said, adding, "But the stakes are higher with these [consumer-driven health plans] because if you're wrong or you have a claim you're on the hook for so much more money." Pollitz added that although consumer-driven health plans have lower monthly premiums, they generally are not as a protective for those who file many claims, which is common during a pregnancy (MarketWatch, 6/12).

People who change to consumer-driven health plans might be "saving money up front with the premiums and [might] have some savings as well, but the insurance is complicated," Alina Salganicoff, vice president and director of women's health policy at the Kaiser Family Foundation and a co-author of the report, said, adding, "This particular model puts even more of the onus on the consumer to make the choices but they don't always have the information to make the choices" (Gardner, HealthDay/CBC News, 6/12). March of Dimes President Jennifer Howse said the findings are "troubling," adding that the report "signals the need for additional research to determine whether the practice of excluding care from the list of preventative benefits is widespread among consumer-directed health plans" (CQ HealthBeat, 6/12).

Thomas Wilder of America's Health Insurance Plans, said, "When you evaluate a high-deductible health plan, yes, you need to look at the deductible, you need to look at the out-of-pocket limit, you need to look at what the premium is versus other coverage that may be available to you," adding, "There's this whole series of measures and questions that you really need to look at and not just say this approach is 'good' or 'not good'" (Washington Post, 6/13). Grace-Marie Turner, president of the Galen Institute, said people could apply the savings on premiums in consumer-driven plans towards out-of-pocket costs, adding that "people have to understand the full costs" (CQ HealthBeat, 6/12).

Related Study
A second study also released on Tuesday examined childbirth costs for women insured through large-employer health plans, CQ HealthBeat reports. The study, compiled by Thomson Healthcare for the March of Dimes, examined health claims from more than 10 million employees, spouses and dependents. It combined the costs of prenatal care, labor and delivery in addition to postpartum care provided during the three months after delivery, finding that the average cost of having an infant with a private health plan in 2004 was more than $8,000.

The report also found that employer-based health care plans covered about 95% of maternity care. The report found that average expenditures for maternity care were $7,737 for vaginal delivery and $10,958 for c-section delivery, and that childbirth expenses are most expensive in the northeast part of the country and lowest in the South (CQ HealthBeat, 6/12).

"Having a baby is the most costly health event families are likely to experience during their childbearing years," Howse said, adding, "An uninsured healthy pregnancy can be a financial strain on young families, and a catastrophe in the case of a high-risk birth" (Feder Ostrov, San Jose Mercury News, 6/13).

The Kaiser Family Foundation report is available online.

The March of Dimes report is available online. Note: You need Adobe Acrobat to view this report.

Kaiser and the March of Dimes on Tuesday co-hosted a forum to release the studies. An archived webcast of the forum is available online on kaisernetwork.org.