Midwives are often asked which health insurance plans have the best coverage for home births or birth center births. Everyone’s financial picture is different, and we can’t give you advice about which insurance plan you should choose. In these times of great change in health insurance, conservative plans rise to the top as a very progressive idea, especially for out-of-hospital births. Christian health care cost sharing plans like Samaritan Ministries and Christian Care Ministry (Medi-Share) are an idea we encourage families to consider when they look at options for paying for their health care expenses. Premier Birth Center supports Samaritan Ministries by not requiring any pre-payment or out-of-pocket expense for Samaritan members.
Most people have commercial insurance, such as Blue Cross/Blue Shield (Anthem, CareFirst), Aetna, Cigna, United Healthcare, etc. These plans are often subsidized by their employer or by the government (through “Obamacare”). Monthly payments (premiums) generally vary according to the size of your deductible and co-payment. HMO plans tend to have lower premiums than PPO plans, but when you have an HMO, you are limited to using the providers within the insurance company’s plan. PPO plans usually have in-network and out-of-network benefits, although some plans do not have out-of-network benefits at all. Some plans allow for an in-network exception. Some plans will pay for all kinds of midwives, some exclude certain credentials. Some will pay for a birth center birth, but will not pay for a home birth.
With commercial insurance, you generally have a deductible, co-payments, and co-insurance. The deductible can be different for in-network vs. out-of-network claims. So, let’s say you have a $2000 out-of-network deductible with a 70/30 co-pay. You will need to pay the $2000 before your insurance will pay anything at all. Once you have met your deductible, your insurance will pay 70% of what they consider to be the “usual and customary” amount for the codes your provider submits on their claims to your insurance, and you are responsible for the other 30%. So, if there are $6000 in usual and customary expenses after the deductible, you will need to pay 30% of that $6000, or $1800, in addition to the $2000 deductible, for a grand total of $3800 out of pocket expense.
There are many variables, and even when we think a plan will pay well, we sometimes are surprised be a claim being denied after the birth. There really is no way to know for sure whether a plan will pay and how much they will pay, so we often will tell people to plan for the maximum out of pocket (no reimbursement at all), just in case there is a surprise. It is better to be prepared for that and then be pleasantly surprised if your insurance pays well, but most of the time people are very disappointed by how poorly their supposedly “awesome” commercial insurance reimburses for their home birth or birth center birth.
Doesn’t a hospital birth cost less than a birth center or home birth?
Often, people look at their commercial insurance and think a hospital birth will cost them less than a birth center or home birth. Sometimes, this is true. But, if they have a deductible and co-pay, they may be surprised to find that their hospital bill will end up costing about the same or even more. Using a $1500 in-network deductible and an 80/20 co-pay as an example, if you had a $15,000-$25,000 hospital birth, you could easily end up with a bill for $4000-$5000.
Christian Health Care Cost Sharing Plans
These plans are not health insurance, although they do “count” as coverage for the Affordable Care Act. As Christian Care Ministry says, they are a “healthcare sharing ministry where members share each other’s medical expenses.” Members pay a monthly “share” instead of a premium.
Each health care sharing plan has slight differences in the way that their programs are run. For Samaritan Ministries, if a member has a qualified medical need, that need is published to the membership. Members will send their shares directly to the person in need, often with a note of encouragement, expressing their plan to keep the family in their prayers. Members have reported feeling very uplifted and supported by the personal and spiritual connection with other Samaritan members.
The monthly share for these plans is quite low compared to commercial insurance. Samaritan Ministries‘ monthly share for a family is $405 (as of May 2016). Christian Care Ministries‘ monthly share varies according to family size, date of birth, and Annual Household Portion (out of pocket cost per year before needs are published for sharing).
The plans have guidelines for their programs available on their websites. These guidelines detail what is and is not considered to be a publishable need, as well as what the qualifications are for membership. Generally, members are required to be Christians and live a Biblical lifestyle.
Samaritan rewards families who choose midwifery care. They waive the initial unpublishable $300 need amount for homebirth and VBAC because “they lower overall maternity costs,” and they also will pay up to $500 for doula services. They will pay in advance of the birth if the maternity care provider discounts the fee for paying in advance.
The big question: What if I transfer?
Good question. We can’t answer that question fully for every person, but in our experience, Samaritan Ministries has handled this very well. The ministry will help negotiate lower fees with the hospital and the remaining hospital bills are handled like other publishable needs.
If you would like more information about Samaritan Ministries or Christian Care Ministry, we encourage you to explore their websites to see if these plans might work for you. Your midwife can also answer questions about her experience with these plans, as well. Call Premier Birth Center at 540-709-1737 for more information about health insurance and Christian healthcare sharing plans.