![]() "There are all these disparate puzzle pieces fitting together and not fitting together," Stich tells CNBC Make It. These self-insured health plans may be run and handled by an insurance carrier, but the company is ultimately responsible for paying out on claims, instead of paying the insurer a premium. Yet large employer plans (those with more than 50 employees) are not required to comply with the essential health benefit requirements.Īlso exempt from these restrictions (unless mandated by the state law) are employers who opt to offer a self-insured (self-funded) health plan, says Julie Stich, vice president of content for the International Foundation of Employee Benefit Plans. ![]() The bulk of Americans, 49%, get their health insurance through their employers, according to the Kaiser Family Foundation. But the ACA's essential health benefit stipulations apply only to individual health-care plans sold through the marketplaces and those offered by small employers (less than 50 employees), which is only a small percentage of plans. On the surface, it seems like that should have solved everything. ![]() The law also blocked insurers from turning away pregnant women and stipulated that maternity care was an "essential health benefit." The ACA changed the rules, allowing dependent children to stay on their parents' health insurance plans until the age of 26. But there are no laws that specifically state companies have to cover maternity care for adult children because, until the ACA passed in 2009, most employer-based health insurance plans cut off coverage when the children legally became adults or upon college graduation. While there are some federal laws that protect maternity rights, Bethany falls into a loophole.įor years, federal laws have stipulated that employers need to cover maternity care for their employees and their spouses. In hindsight, it would be more affordable if Bethany was unmarried and therefore had a lower household income so she could claim Medicaid benefits, or if she taken out her own policy through a marketplace. They had no idea about the dependent exemptions until it was too late, Bethany says. It seemed ideal: Her parents have had some health issues in recent years, which meant they always hit their deductible. Young adults can remain on their parents' insurance until they're 26, regardless of marital status. But because her husband has had a few different jobs since graduating, most of which were contract positions with lackluster benefits, Bethany opted to stay on her mom's insurance. Meanwhile, should her 23-year-old brother need an ultrasound to treat a tendon tear, his care typically would be covered.īethany married her college sweetheart a year and a half ago. A 20-year-old woman may need multiple ultrasounds during her pregnancy and end up paying thousands out-of-pocket. "It feels misogynistic to me," Bethany says. Bethany says her Michigan-based insurer, ASR Health Benefits, said her mother's health insurance plan doesn't cover maternity care for adult dependents and only paid a portion, about $1,000, of that initial OB-GYN bill that it deemed "prenatal care." ASR did not respond to multiple requests by CNBC for comment and clarification of its policies. And getting a $3,000 bill for a single OB-GYN visit.īethany and her husband had no idea insurance was going to be an issue, since she's insured through her parents' plan. ![]() What Bethany didn't expect: Learning her insurance company wouldn't cover the vast majority of her medical expenses during her pregnancy. The office drew blood and ran tests, and her doctor spent time talking to the couple about what to expect during the pregnancy. "When we found out, I scheduled an OB-GYN visit to figure out next steps with prenatal care," Bethany says. They learned the upsetting news at their very first doctor's appointment. Despite Bethany's best intentions, only a small fraction of her pregnancy-related health-care costs are covered by her insurance company. ![]() But while the couple planned to have a baby, they weren't expecting it to be so expensive. ![]()
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