Enhanced coverage of maternity services for pregnant women under the Affordable Care is proving to be a challenge for insurers, reported the Associated Press.
Low-income women who sign up for a private plan sold on a health insurance exchange also can obtain maternity coverage through Medicaid, regardless of whether their state has expanded their Medicaid program. That means Medicaid could be supplementing private insurance for some pregnant women.
Because states have different Medicaid eligibility standards, insurers have to work with multiple state officials to determine who gets coverage and when. Due to these discrepancies, state and federal computer systems must be reprogrammed so they recognize pregnant women can legally receive insurance coverage from both Medicaid and exchange plans.
"This is an issue where women are going to have to figure out, 'I'm eligible for both, now how do I do that?'" Matt Salo, executive director of the National Association of Medicaid Directors, told the AP. "But what a wonderful problem to have. This is a great problem to have from the consumer's perspective."
Depending on each woman's circumstances, it might be better to receive coverage through Medicaid now that most states require comprehensive maternity services. Conversely, a pregnant woman enrolled in an exchange plan potentially could save thousands of dollars if she opted into Medicaid as well, Dipti Singh, an attorney with the National Health Law Program in Los Angeles, told the AP.
What's more, a HealthPocket analysis found only 2 percent of insurers offered all benefits required under the ACA as of last spring. The greatest deficiencies included coverage for maternity and newborn care, FierceHealthPayer previously reported.
To learn more:
- read the Associated Press article