What is the best health insurance plan for an expectant mother?
This is one of my favorite questions to answer. Instinct might tell us that we should upgrade our insurance. After all, we need to protect our growing family. In actuality, you're often better off going with the lower-cost health insurance plan. Counterintuitive, right? Let me show you the math.
$18,865 = the cost of childbirth in the United States. Just so we're clear, that's the cost of a "normal" pregnancy where everything went right.
Expectant mothers should expect to blow through their Out-of-Pocket (OOP) Maximum -- this is the maximum dollar amount per year that you have to pay for services covered by your health insurance plan. For 2025, the maximum OOP by law is $9,200 per individual and $18,400 per family.
Here's the thing: OOPs don't vary that much across plans. The table below shows examples of individual health plans that I quoted for myself (Location: San Francisco). You'll see that the Gold Plan has an identical OOP to the Bronze Plan. $8,200 sure is a lot of money, but it stings less if you have an ICHRA Health Wallet to pay down your OOP. Let me walk you through the math.
Say you receive $1000 per month from your employer through an ICHRA.
The Platinum Plan will cost:
$329 x 12 (payroll deduction)
+ 4,000 (out-of-pocket maximum)
Total Cost for the Year = $7,948
The Bronze Plan will cost:
$0 (payroll deduction)
- $6,403.68 (Health Wallet)
+ 8,200 (out-of-pocket maximum)
Total Cost for the Year = $1,796
Are you starting to see it?
There is one complication to this math. Once born, your baby will need their own health plan and will have their own OOP. That could be another $8,200 in expense. For the baby, my advice is the opposite. Buy the plan that has the lowest OOP (usually Platinum). I price this out in the Google Sheet linked in the comments.
Now, some of you might come at me and say this only applies to the individual market. But, over the past 3 years, I've helped friends & family who were covered on a group plan with picking out options. The outcome is almost always the same: buying a health plan with a lower-cost premium is always in the family's economic interest. Some exceptions to this:
- The employer's health plan has a low OOP AND the employer is covering 100% of premiums
- Total payroll deductions for the year + OOP of the "upgraded" plan option is LESS THAN the OOP of the lower-cost plan
Sharing this all with the world in case this helps you or someone you know this Open Enrollment season!