Self-employed as a freelancer, responsible for my own health insurance, I was on the cheapest bronze-level Obamacare plan when I got pregnant, with no option to enroll in a different plan. Before I got pregnant, I tried to research the costs of a normal, healthy pregnancy on such a plan. But I had trouble finding any concrete numbers, or any women sharing their experience with real numbers all the way through the pregnancy. So, I’m sharing my numbers, now that it’s all wrapped up and I can speak definitively about what the costs were.

If you’re here for the first time, you may want to go back and read the details of my first trimester costs and second trimester costs (they are also summarized below, with the final total for the whole pregnancy).

The third trimester is intense, both physically and medically. The standard once-a-month visit to the obstetrician (OB) escalates: first to biweekly, and then to weekly. You get poked, prodded, and fed sickeningly sweet glucose solutions. And your pee is tested just about every five minutes – good thing most pregnant women already feel their bladders filling up that often!

Non-Money Obamacare Thoughts

A few things happened with my Obamacare plan and my pregnancy that didn’t have to do with money per se. And most of them happened in the third trimester, of course:

Insurance Needed to Be Verified, Over and Over

Several times, I would show up at a new facility – family doctor, OB’s office, hospital, ultrasound imaging center – and they’d have to verify my insurance. Not just “here’s my insurance card and ID” verify, but rather, they would spend five minutes with my insurance card, then come back to me and say it was going to be a while longer because they had to call up my insurance. Most of the time that this happened, the receptionist processing it would make a point of saying “We have to verify that this will be covered, because this is an Obamacare plan.”

Things That Were Supposed to Be Covered Were Rejected

My best example of this was my husband’s tetanus vaccine – the Tdap. Recommended for anyone who is going to have contact with an infant (because of the “p” in Tdap: pertussis aka whooping cough), this was one thing we were definitely not about to skip. But, we went to two different supposedly-covered pharmacies to get it, and both of them told us our insurance was rejecting it. We paid out of pocket at the second pharmacy, just to get it done with. But all vaccines are supposed to be covered in our insurance, and neither pharmacy nor our insurance company could explain to me why it wasn’t covered.

Address Change Was a Nightmare

We moved in July – within the same zip code, so it barely affected anything, and it should have affected our insurance not at all. I keep a huge spreadsheet of every single online account and whatnot that requires an address change when we move, and it’s a big pain in the butt. (I hate moving.) But updating the insurance was one of the first ones I thought to do… and then it became one of the ones that took the longest. I contacted insurance, they told me it had to be updated on Healthcare.gov. Okay. So I updated my address in my profile on Healthcare.gov, and got a confirmation.

Done, right? I thought so! But weeks went by, and my address never updated on my insurance company’s website. I called them to ask why, they said they hadn’t received the update from the Healthcare Marketplace. Odd. So they called the Healthcare.gov customer support line, and we did a conference call. The Healthcare.gov rep dodged the question, and was really suspicious of the fact that a rep from my health insurance was on the line. Huh? So I had the health insurance rep hang up, and I talked to the Healthcare.gov rep directly.

Turns out, if you move, even within the same zip code, you have to file a whole new Healthcare.gov application. Well, that’s a pain and a half. What really rustles my jimmies about it is that they don’t tell you that when you log in. They have a “Profile” section with your address that you can update, but this doesn’t actually do anything (except make you think you’ve updated your address!). The only way to know I was supposed to file a new application would have been to have called, or to have searched for “How to change address Healthcare.gov” instead of just, you know, logging in and trying to do it. They’re working off the assumption that you will ask for help to change your address.

I redid my application, submitted it, and eventually it did get updated with my health insurance. Except, things were never quite right with my mail after that – I stopped receiving my Explanation of Benefits (EOB) papers in the mail altogether after the address change. Considering that some of them aren’t available in my online account, I ended up having to call my insurance again to ask that the missing EOBs be mailed to me.

Health Insurance Rebate

I got a check for $29.65 from my insurance company. It came with a letter that said:

You are getting a premium rebate.

Sometimes our medical costs are higher than we planned. Sometimes they are lower. Under health care reform law, health care plans must spend a minimum amount on medical costs and quality improvement activities. When our costs are less than that minimum amount, we pay premium rebates to subscribers like you.

Sweet.

I’m not including this in the costs calculation below, because it was a rebate on my premium, not on the costs of the pregnancy. But, it’s worth noting. Technically, it’s a 0.6% reduction in the cost of my premium!

Bills, Bills, Bills

So many bills came in the mail after my delivery. Big bills, small bills, bills for $0, bills that didn’t have payments I had made reflected on them, bills that didn’t even look like bills… and then at least one “Explanation of Benefits” from the health insurance for every bill. (In fact, another EOB from the birth arrived today… at the end of January, almost 3 months after the birth itself. What?)

The flurry of paperwork was overwhelming, and somehow, I was expected to keep track of it all and make timely payments… while functioning on 2-hour bursts of sleep (at best) and managing a newborn. And then I had to submit all that paperwork to my Health Savings Account (HSA) to get the money out to pay the bills!

My Real Third Trimester Out-of-Pocket Costs

Now that the touchy-feely non-numbers stuff is out of the way, let’s dig into what I actually had to pay! (Above and beyond my insurance premiums, that is):

Breast Pump – $0

One of the really nice things about Obamacare is that it made sure that health insurance plans must cover the cost of a breast pump. Different health insurance plans use different “medical equipment suppliers” to conform to this requirement, so it’s best to contact your insurer to find out how and where to get yours, and if you need a prescription from your doctor. My insurance used Edgepark as their supplier, so I took a look at the different electric pumps they offer, and selected the Spectra S2 “hospital-strength” double pump.

One thing they don’t tell you when you order a pump is that you will end up buying several accessories for it. I haven’t included the costs of those accessories here because they were purchased after the pregnancy, once I figured out I needed them! But word to the wise: the flanges that come with your pump will likely not fit you. Heck, Spectra doesn’t even make a size flange that fits me! I had to buy off-brand on Amazon to get the right size.

Doctor Visits – $54.00

Since all prenatal care (in-network) is supposed to be 100% covered by insurance, this stayed pretty low. I only had to pay for a visit to my regular primary care doctor, to get my third trimester vaccinations (Tdap and flu shot). Not bad at all.

Drugstore – $76.17

More prenatal vitamins, and we also got the Tdap vaccine for my husband at our local CVS. See above for my annoyance on having to pay out of pocket for this… but in the end, it didn’t end up being much more than if we’d had him go into the doctor for it: $64.99 out of pocket at CVS vs. $54.00 for the doctor’s office visit to have it done there. It was just annoying to be told by two in-network pharmacies that the vaccine wasn’t covered.

Lab Work – $5.99

Only one test to pay for in the third trimester: the Group B streptococcus test that all pregnant women get.

RhoGAM Treatment – $208.42

Because I have a negative blood type (A- baby, just like my grades in high school!), and my husband’s is positive, I needed to get two of these at the hospital – one in the third trimester, and the other on the day after delivery. This was just the cost of the first treatment. The cost of the second one is wrapped up in my labor and delivery charges, below.

Labor, Delivery, & Hospital Stay – $6,140.35

Boom, there’s the big tamale! That was:

• Obstetrician: $1,325.35 (+$250 deposit, which was counted in the second trimester, when I paid it)
• Hospital: $4368.00
• Newborn tests and screenings: $447.00

Needless to say, I finally hit my $6,850 deductible!

Now mind you, this was for a normal, healthy, vaginal delivery without complications. Literally, my bill from the hospital charged it as “Vaginal delivery w/o complicating diagnoses.” But I suppose that if I had experienced any complications, I would not have paid more, since I hit my deductible. I guess that makes it sort of a flat rate, no matter what! 😛

My Total Pregnancy Costs on Obamacare:

Total Out-of-Pocket Pregnancy Costs: $7,536.88

Health Insurance Premiums for the Year: $4,446.23

Wow. That’s… a staggering number. Does that seem high to you? That seems high to me. Honestly, I didn’t even really know it was that high until just now, since all the bills came in at different times, and there was confusion over some bills, and all that jazz. This is the first time that I’m looking at the total number, and… wow.

Remember this little graphic from my Summary of Benefits paperwork from the health insurance company?

Guess they were right to say “Don’t use these examples to estimate your actual costs under this plan.” Harrumph.

How much would it have been without insurance?

That’s a good question, and sadly, not one I have time to answer. As I said above, I got a ton of “Explanation of Benefits” papers from the insurance company. With a new baby in my life, I just don’t have the time to go back through them all and tally up the totals of how much each facility charged to my health insurance. But… let me put it this way: There was one bill for over $8,000 that was 100% covered by my health insurance (because I had hit my deductible already). So I can very safely say: without insurance, it would have been more than double what I ended up paying: $16,000+. (For a very standard, normal pregnancy without complications!)

I have questions. Questions that really have no answers, but I have them anyway: Why does this all cost so much? How are people supposed to keep track of all this (I’m a spreadsheet-loving Type-A crazy person, and I had trouble keeping track!)? Why isn’t pregnancy an event that qualifies you for a “special enrollment period” so that you can change health insurance plans? How are people supposed to PAY for all this?

We were really only able to pay all of these bills because years ago I had a job that offered a very generous HSA match, and I had never touched that money before the pregnancy. We spent everything that was in our HSA, and a good chunk of what we were able to add to it during the pregnancy, too. And now I have to choose between expensive day care and not being able to work much – how would we pay those bills if we hadn’t had the money up front? I really don’t know.

Have you gone through a pregnancy or other major medical expense on Obamacare? If so, I’d love it if you shared some info about the costs you incurred in the comments below. Or if you have a low-cost Obamacare plan – do you have any questions for me or others about our experiences?

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I’m pregnant, I’m self-employed (as is my husband), and we’re on the absolute cheapest Healthcare.gov (a.k.a. Healthcare Marketplace, a.k.a. Obamacare) plan. So, what’s it like being pregnant on Obamacare? What’s it cost?

The second trimester is supposed to be the easiest: morning sickness lets up for many women, the risk of miscarriage is lower (which in turn lowers anxiety and stress), the growing belly isn’t as physically uncomfortable as it will be in the third trimester… all-in-all, these are supposed to be the good times! But are they easy-breezy financially for someone on a Bronze health insurance plan? Let’s see what happened to me during this time.

If you missed the previous post about my first trimester, here’s a little review of my health insurance plan: there is supposed to be no charge to me for prenatal care (before the baby comes), and then delivery and postnatal care are covered once I have paid my deductible for the year, which is $6,850. This is for in-network doctors/facilities/services only. If I were to go out-of-network, my deductible would be a whopping $20,000 – and prenatal, postnatal, and delivery care would all only be 50% covered after the $20,000 deductible. Basically, out of network? Screwed. And that became very relevant during my second trimester, unfortunately…

My Real Second Trimester Out-of-Pocket Costs

Weeks 13 – 27 of my pregnancy! As with the first trimester, I’m laying out all of my pregnancy-related health costs (other than extra food, because that’s hard to measure) just so that you can see everything. Some of these things wouldn’t be covered by any health plan, and that’s fine. But others…. well, let’s have a look:

Doctors’ Visits: $0.00

I wasn’t charged for any of my prenatal checkups with the obstetrician’s (OB) office in the second trimester, which is good! But, there was a big scare with my health insurance during this time. I got a letter in the mail, from the insurance company, stating that my OB’s office was no longer accepting my health insurance, starting right away, and I could continue to go but it would be considered “out of network.” Uh… say what?

This was a really scary letter to receive, from a financial perspective. That $20,000 deductible immediately popped into my head – as it should have! That’s exactly what this letter was saying: my formerly in-network OB was now out-of-network, and would be subject to the higher deductible and the reduced coverage after that (as if I could pay a $20,000 deductible in the first place). I was scared, and pretty peeved: I had chosen this OB practice because they were one of only two places that were in-network and delivered at the hospital near me. And now… they weren’t?!?

I took the letter into my OB’s office on the next visit and had them look into it. They were great – they called the health insurance company for me, and figured everything out. Yes, there was a contract dispute going on between the medical group (that the OB’s office is a part of) and my insurance company. And that contract dispute was only over certain Obamacare plans, so it only affected a small subset of women… including me. (Still a bit of a relief to know this wasn’t a widespread problem, even if I was still the one caught in the middle.) In the end, the dispute did cause the medical group to drop out of the low-cost Obamacare plans with my insurer.

But still, my OB’s office took care of it. They had me fill out “Transition of Care” paperwork, and they submitted it to my insurance company for me. And my insurance company accepted! As a result, the OB’s office is still considered in-network for me, through the end of the year. Yay! I was very worried that I’d have to switch doctors right in the middle of my pregnancy, but I dodged the bullet there. Still, I’m very lucky. The timing of my pregnancy has everything to do with it (my pregnancy is all within one calendar year). With different timing, I could have been stuck either desperately shopping for a plan that I could afford that included my OB, or switching doctors partway through just for financial reasons. 🙁

So no money spent on doctor’s visits, but there was a lot of stress about money and doctor’s visits, which I can’t even put a price on. I tried not to let myself get too anxious, and reminded myself that if I had to switch doctors, it would be okay. Annoying to do, stressful, and weird, but I’d get through it and the baby would probably be fine.

Lab Work: $0.00

None during the second trimester! Of course, it probably helps that we passed up all prenatal genetic testing, due to cost and the fact that false positives are relatively common (leading to more costly, more invasive procedures that would have also not been covered by my insurance).

Drugstore Expenses: $28.50

Not too shabby at all – this was for a prescription for a urinary tract infection that I was diagnosed with right at the start of the second trimester, and for some more prenatal vitamins (I went with the gummy kind this time!).

Classes: $125.00

We took the Childbirth Education Class offered by our hospital at my OB’s office. We ended up being the “youngest” couple in the class (about 10 weeks behind the gestational age of the other fetuses in the room!), because I didn’t realize it’s the type of class you generally take in your third trimester. But, the class was very good, and the nurse teaching the class offered to be available for questions later, if we ever felt we needed a refresher.

This class was well worth the cost, but it is the only class we took during the pregnancy, due to time and costs. There would later be a breastfeeding class included in my delivery, which is an idea I really like because I don’t think I would retain much from a breastfeeding class if I took it before I was able to physically breastfeed!

Delivery Costs: $250.00

Wait, say what? In the second trimester? Don’t worry: I didn’t go into super-early labor. But I did have to pay that $250, as a deposit to my OB, because of the Obamacare plan (I guess they’re worried that the insurance may not pay them much, and then that I’ll be super broke and not able to pay them, either). The OB’s office called me one day to bring it up and ask me to pay, and so that’s the entirety of these “delivery costs” for the second trimester.

That’s it for second trimester costs! Let’s see how that all adds up, and compares to the first trimester:

Running total so far: $1,051.95

Starting to really add up! When I look at that number, I can’t help but think about how nearly half of all Americans couldn’t come up with $400 for an emergency if they needed to. My second trimester alone cost me $400! As does my monthly insurance premium! And the third trimester is shaping up to be much, much more (at the time of this writing, the third trimester is done and the baby is here, but the bills are still rolling in, so it will be a little while before I have final numbers). How could it even be possible for most people to handle pregnancy costs on Obamacare insurance?

The sad answer: it’s not possible, not without taking a drastic action – usually debt. I’ve put every single pregnancy expense on a credit card – I just happen to be in the fortunate situation where I have money socked away in an HSA (Health Savings Account) to pay those credit cards off immediately. If it weren’t for my savings, I’d be paying these credit card bills for years, and wracking up quite a bit of interest along the way. How much interest? My guess is “somewhere in the $1000s,” but I’ll do a real estimate when the third trimester numbers are in.

Stay tuned for the third trimester and delivery costs! You can follow Poorer Than You’s Facebook page or subscribe via email to be alerted when new posts go up.

Disclaimer Thing: The information in this post is 100% accurate (as far as I know), but it is only one example of one woman (me!) being pregnant on Obamacare. Your mileage will vary, based on the health insurance plans available in your state and your zip code, your individual medical situation, and pure simple luck. I provide this information because I felt discouraged before my pregnancy by not being able to find examples of how much a pregnancy really costs on Obamacare — so now that I’m in a position to provide that example to others, I’m happy to do so.

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