This post is re-published from The Colorado Independent, as part of an editorial partnership between RH Reality Check and the Center for Independent Media, the non-profit that operates Colorado Independent and five other state-based online news sites.
In advance of a bill in the state legislature that would require
Colorado’s insurance companies to cover maternity, The Colorado
Independent searched for non-employer-based maternity health insurance.
How did it go? It was unbelievably frustrating.
Posing as a 34-year-old woman from the high country whose COBRA
coverage was running out, this reporter perused websites and called
agents to explore the options.
In hours of searching, I found no single plan that would cover standard maternity care for a woman in rural Colorado.
“You just can’t get maternity,” explained one agent. “You first have
to get the health insurance and then you add the maternity as a rider”
to the policy.
I found three companies offering “maternity riders” on top of
available health insurance plans. But in many cases, even the agents
earning a commission to sell the plans acknowledged they weren’t very
“Maternity benefits on the open market are crummy in Colorado right now,” said one agent. “It’s pitiful that it is that way.”
My first call went to Rocky Mountain Health Plans,
since the company turned up high on a Google search for maternity
insurance in Colorado. The agent immediately asked for a birth date and
then said that a 34-year-old woman would be too old for the plan by the
time it went into effect. Maternity coverage is only offered to women
between the ages of 17 and 34 and three quarters, she said.
According to state underwriting guidelines,
the Rocky Mountain Health Plan maternity rider is also not available to
any woman with a previous history of pregnancy complications, which
include for example a miscarriage, toxemia, pre-eclampsia, cesarean
section, etc. The maternity rider is also definitely not available to
any woman who is already pregnant–nor is it available to any adult
member of a pregnant woman’s family, apparently to guard against fraud.
So, too old to have a baby with Rocky Mountain Health Plans, The Colorado Independent turned to ehealthinsurance.com, figuring that of the 112 plans listed for a 34-year-old woman in rural Colorado, there must be options.
Yet, according to the agent I spoke with, only one company on the site, United Health, offered a maternity rider.
For $106, The Colorado Independent could add a maternity rider onto
a United Health plan, which sounded good. But it wasn’t good. In the
first two years, the plan only covered $2,500 worth of maternity care.
Since the average cost of prenatal care and delivery in Colorado
falls between $10,000 and $16,000, according to the agents I
interviewed, this plan wouldn’t come anywhere close to covering the
pregnancy— even with discounts negotiated by the health insurance
I called a local agent in the high country. He said he could sell a plan through Assurant, but warned that it would be a risk.
He explained that for about $250 a month, a 34-year-old woman could
add a maternity rider with a $2,500 deductible to an Assurant plan. She
would need to wait three months to conceive. The hitch, he explained,
was that she may or may not actually get to use the maternity benefit.
Most women, he said, find they spend between $1,500 and $2,000 on
prenatal care— that is, before they ever hit the delivery room. For a
normal pregnancy, then, a woman would go into the hospital with only
$500 to $1,000 of her deductible left to pay, he said, expecting the
insurance to cover the rest.
But, he explained, if the pregnancy has any complications (like a cesarean section or any other complication as defined here by the Colorado Division of Insurance), suddenly the primary policy—with its separate deductible—picks up coverage.
When that happens, he said “your maternity benefit is totally null
and void. It’s not being used…. It can get messy. And it’s horrible.
I’m not going to sugarcoat it.
“So it’s expensive,” said the local agent, “and it could not work
for you in the long run. But it’s sometimes better than nothing if you
can afford it.”
He joined most of the other agents I spoke with in criticizing the products he was selling.
“Do you have access to an employee-sponsored insurance plan,”
inquired one agent, helpfully, suggesting the applicant try to get
group coverage somehow. “Do you own your own business or does your
spouse or significant other?”
“Honestly,” said another, “your best bet is to work out a cash discount with your provider.”
Another agent “highly suggested” I check again to see if COBRA
coverage would last long enough to carry through any pregnancy and
“Group plans in the state of Colorado have maternity mandated,”
explained one agent. “They have to offer it. The individual plans do
not and typically they do not offer it. Because it can be expensive if
you have a premature baby, and they don’t want to have to cover it.”
When I pointed out that every plan in Colorado is required to cover
a premature baby, even if the mother does not have maternity coverage,
the agent acknowledged that was true.
“Yeah, yeah, it would [be covered],” he said. “So it doesn’t really
make sense to me, but for some reason [insurance companies] have
decided not to cover maternity in a lot of states now because, I guess,
of the expenses that can go along with it.”