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From what I've experienced, prenatal care should be fully covered per the ACA. I actually didn't pay any copays the entire time. I think the deductible would come into play for delivery. http://www.hhs.gov/healthcare/facts/factsheets/2012/03/women03202012a.html

I had to pay out of pocket through my deductible. I met my deductible ($750) after the initial appointment, which included an ultrasound and bloodwork. After that, my prenatal appointments were covered, without a copayment. Even my next two u/s were free of cost, which I didn't fully understand. My labor and delivery was 70% covered, but I had a $3,000 out of pocket max, so that is what we owed, in the end.

I had a 3000 deductible. So I paid for all up front until I met that.

Just be aware that there's a difference between a deductible and an out of pocket max. Some people have zero, one, or both of these.

For example, I was responsible for all medical costs (save for preventative care, per the ACA) up until the amount of $750. Only then did my insurance kick in, and start picking up my medical care, at 70% coverage. I was still responsible for 30% of costs, outside of preventative care visits (I believe routine prenatal visits fell under this umbrella, as I didn't pay again until my l&d).

We had a $3,000 out of pocket max. That's the top dollar amount I could be expected to pay in a calendar year, before my insurance picked up everything 100%. Our L&D bill was about $30,000, so we paid $3,000 of that amount, and insurance covered the rest.

@yoursilverlining: The happened to me. I paid $750, twice, as I was pregnant from October 2012-July 2013.

@yoursilverlining: I was also bummed to realize that I wasn't contributing to my OOP until my deductible was met (twice). Pregnancy taught me so much (crappy things) about insurance!

@snowjewelz: are you on an individual or family plan?

@snowjewelz: I have the silver plan (my office reimburses) - I would go to their website (look for the Estimation of Cost of Procedure or something like that link) or call Blue Cross.

If you are calling, you might as well check one other thing off your pregnancy list and ask about breast pumps and how you go about getting the pump that is covered by BCBS. There is also a program called like "Baby Yourself" that you can enroll in that gets you some free swag and access to a nurse 24/7.

Every insurance is so different, that it's really hard to say. I paid $300 at my last prenatal visit that covered all the prenatal care, basic delivery, and first pediatric evaluations. I will be billed for other hospital costs, anasthesia, etc.

You should be able to call your insurance and get an EOB (explanation of benefit) and an estimate of cost. It's very helpful for planning/budgeting purposes!

According to my insurance company when I called. Each person on your policy uses the individual deductible, so for you, and you only, you will have to accumulate $700 in expenses (not $1,400) before you meet the deductible. So after you pay $700 your 80%/20% will kick in and you will pay 20% of costs up to your individual out of pocket max of $4,700.

If you husband has any major medical issues in the mean time, he would also have a $700 deductible and $4,700 OOP max.

It's my understanding that where the "Family" deductibles/OOP max come into play is when you have more than two people. Each person will have their own $700 deductible they will be counting towards, but the max family deductible is $1,400.

I don't know if this makes any sense. That is how my insurance described it to me, and I suppose all insurance companies could be different.

Where I'm still confused is what happens when baby is born. Are they now their own person, subject to their own individual deductible, or will they be counted as one with the mother at birth?

@snowjewelz: Dealing with the insurance companies is always so hard. Is there a section on the SBC that indicates "if you have a test"? Something indicating coverage for diagnostics? We have no charge for our lab work, but DH's plan includes that in the deductible. That's a great question for them. Just asking what is included within the deductible will help you to get a better idea of what your costs will be. If I can help in any way...PM me, and I can send you my email address to take a look at any documents you have to make some sense of them.

@MsBadger: Right! Worst case scenario will be your OOP Max. All copays and deductibles should count towards your OOP Max EXCEPT prescription copays. They're the only ones excluded under ACA right now, but they'll be counted towards the OOP Max beginning 1/1/2015 per ACA.

One thing to consider...you might have a totally healthy pregnancy, but end up with something like GD. I did, and ended up having to get non-stress tests twice per week up until the birth of LO. Those were included under the deductible. So I first had to meet my deductible (which I did with my lab work since I was under DH's insurance at the time), then had to pay 10% of the cost of the remaining balance of the NST since that was my coinsurance. The percentage that you pay is called coinsurance. So I was getting pretty close to our OOP Max with those alone, then met it with LO's birth since I had to have an emergency C-section and LO had a 2 day stint in the NICU. Once we met the OOP max (me and LO combined for the family OOP Max), the plan started paying 100% and we weren't responsible for any of the remaining charges that year.

@snowjewelz: Right! Prenatal office visits are usually covered at 100% once you pay your initial copay when you go for your first visit to the OB. Sounds like that's what you did. U/S that are routine are also usually covered, but sometimes, depending on how they're coded, they'll be considered diagnostic and might be subject to the deductible and coinsurance. Keep me posted on what you find out when you call!

@snowjewelz: Thank you for asking this! I've been completely freaking out/upset (yay hormones) because I just found out that the new insurance that DH's company switched us to has no in-network doctors in our state. It looked like that meant it was going to double our costs for l&d. But, now that I've read through this, I went back and checked, and our deductible and out of pocket max are very close to the same for both in-network and out, and our max is very low. So odds are very high we'd be meeting the max either way, so it's only about $250 than it would have been, not doubled like I was thinking. Thank you for asking questions I didn't even know to ask!

@snowjewelz: Yes! I was picturing it being thousands and thousands if something went wrong. Our max is more than I'd *like* to pay, but well within our ability to handle.

@snowjewelz: First, find out if your deductible is aggregated.

By looking at it, it SOUNDS like your entire family needs to meet that $1400. It doesn't matter what combination. One person, two, or even all three of you could have claims combined that meet that deductible level.

Our plan is aggregated. That means prescription co-pays and our 90/10 does NOT kick in until that deductible has been satisfied in full. It isn't equally divided into threes (or fours, once this baby arrives).

The key word is aggregated. Our plan also says individual/family, but since it's aggregated it the "individual" kind of throws you off!