Here’s why people are paying more to get pregnancy care than ever before

health

Tip: It has to do with rising health insurance costs.

In a discussion of affordable health care, a new study by the Massachusetts Health Policy Board (HPC) looked at why individuals have been paying more and more for pregnancy care over the past few years. ..

HPC has discovered that the problem is not the increased cost of care itself, but the bloated out-of-pocket costs of deductions.

What this means is that individuals are paying a higher percentage of their pregnancy costs than before, because of their high deduction health insurance plans.

This study reached these conclusions by examining health care out-of-pocket (OOP) spending associated with all parts of the pregnancy process, from pregnancy to postnatal care for Massachusetts people.

OOP spending is part of the medical costs paid by an individual. This includes deductions paid by the patient, out-of-pocket costs, and joint insurance.

HPC used commercial health insurance cost data from 2016 to 2018 to assess OOP spending for those years.

HPC has found that deductible spending accounts for the majority of OOP costs associated with pregnancy and childbirth, or 65%, and has increased over the past few years.

The average cost of pregnancy and childbirth also rose from $ 21,070 in 2016 to $ 22,000 in 2018, but HPC found that patients paid most of these costs.

The average OOP cost increased from 5.3% of the total cost of pregnancy and childbirth in 2016 to 6.3% of the total cost of 2018. This has increased the average OOP cost for pregnancy and childbirth from $ 1,119 in 2016 to $ 1,372 in 2018.

But within OOP costs, what’s swelling is deductible spending. From 2016 to 2018, average spending on deductible pregnancy and childbirth costs increased by 25%, according to the HPC.

“The deductions are not only the largest part, but the fastest growing,” said senior researcher Sasha Albert. “Out-of-pocket and co-insurance have increased over the last three years, but not so much.”

According to HPC, the reason for the increase in deductible spending is that more and more people are enrolling in highly deductible health plans. This requires less monthly costs, but takes into account more OOP costs before insurance covers medical costs.

As of 2022, IRS defines a high-deductible health insurance plan as a health insurance plan with a deduction of at least $ 1,400 for individuals and $ 2,800 for families.

As of 2019, 85% of Massachusetts commercial insurance residents with non-group coverage and more than 60% of commercial insurance residents employed by SMEs have high deductions, according to HPC. I had a health insurance plan.

“In general, people who have babies are more likely to be young and healthy and may not have run out of many of their deductions at other costs in a particular year. Will be spent [pregnancy and birth]”Albert said.

The HPC also states that the most powerful indicator of the amount a patient pays for OOP costs for pregnancy and childbirth is the size of the employer, which is further due to the increased costs primarily due to the structure of the insurance plan. is showing.

In 2018, HPC paid an average OOP cost of $ 2,385 for patients with non-group coverage, while an average OOP cost of $ 2,007 for patients working in a small business with 1-50 employees, 500. Patients working in large companies that employ more have paid an average OOP cost of only $ 914.

In addition, HPC found that OOP costs for non-group patients and those working in small businesses increased dramatically between 2016 and 2018.

OOP costs for people with non-group coverage increased by an average of 41% over the two years, while those working in up to 500 companies increased by an average of about 29%, and more than 500 people working in large companies. In that case, the OOP cost increased by only 12%.

HPC reflects the highest deductible spending between non-group coverage patients and those employed by small businesses, with a high percentage of highly deductible health insurance plans for these patients. HPC discovered that it was.

“In Massachusetts, insurance coverage is high for both individual patients and small employers, so we have more deductible plans to keep the total cost of insurance down. More employers and employees are choosing, “says Albert. ..

These increasing costs have a significant impact on low-income residents who want to have children. According to HPC, in addition to other costs associated with childbirth, such as baby products and babysitters, pregnancy and childbirth alone can reach nearly 3% of the annual income of low-income households.

HPC said in its report that when patients cannot afford to care, they often simply forget about it. This has an even greater impact on Hispanic and black non-Hispanic families who report having a higher rate of difficulty paying for their health care than white non-Hispanic families.

The HPC said it encourages families to use low-cost doctors and hospitals more often, such as certified nurse midwives and birth centers, but the findings in this new report show pregnancy. It suggests that it may not be enough to keep the birth at an affordable price.

The best way to prevent childbirth from becoming an undue financial burden is to change the structure of your insurance plan to avoid high deductions.