How to find good surrogacy insurance in the ACA marketplace?
Affordable Care Act (ACA) Marketplace plans are an option for insurance coverage for surrogacy. There are small windows of opportunity to register for an ACA plan. The open enrollment period is November 15th and extends to December 15th. Some states do have a longer windows so be sure to verify your deadlines. The available plans and prices will vary not only by state, but also county. ACA plans have been in flux in recent years as we’ve seen a rise in premiums, fewer companies offering plans, and wider restrictions on surrogacy. Nevertheless, there are still usable insurance plans on the ACA marketplace for surrogacy.
Whether you’re an intended parents hoping to find a good marketplace plan for your gestational carrier, or if you’re a surrogate in need of a health plan now that you want to use for surrogacy later on, here are the steps to take when looking into ACA plans.
On the HealthCare.gov website select “preview plans”. Enter the zip code for your gestational carrier.
The next screen allows you to put in specific information to see if you qualify for discounted rates. For simplicity of this example, and to see what generally applies for surrogacy, we will be looking at the full-price plans and skip these steps.
Here we see that there are 22 plans available in this county. I have the plans sorted by the monthly premium cost. The first on the list is Cigna Connect 1500. From this page we can get an estimate for how much it would cost to use this insurance for surrogacy. Let’s say we need a plan for 18 months (2 months pre pregnancy + 10 months of pregnancy + 6 months postpartum coverage). We should also budget to reach the “out of pocket maximum” since maternity care is expensive and anything can happen along the way.
Total cost = Monthly premium x 18 months + out of pocket maximum
$496.50 x 18 = $8937 Monthly premium over 18 months of coverage
+
$8150 Out of pocket maximum
$17,087 Total is a pretty good rough estimate for what this plan would cost us.
*Note: for 2021 the out of pocket maximum is rising to $8550
Clicking on the blue “Plan Details” button brings us to even more information about this health plan. This is a great place to gain understanding of a plan that you may want to purchase. It is also where you will find the links to the hugely important Policy Booklet to see if you can even use this as surrogate friendly insurance. Click on the “Plan Documents” subsection.
Of the 4 options, the Summary of Benefits will bring us one step closer. The Summary of Benefits is a brief overview of what an insurance plan covers and excludes. We want to take a deeper look. We want the big book with ALL the information. Near the top of page one, this Summary has a link to the Policy Booklets. Sometimes this link is on the second page of a summary.
Cigna has laid out the documents for their plans sorted by state. I started with a Virginia zip code so I’ll open that section to find the plan I was looking at on the Marketplace. The “Cigna Connect 1500 – On Exchange [PDF]” get us to the Policy Booklet finally.
And now that we have the Policy Booklet we can use the search feature to look for the terms “surrogate”, “surrogacy”, “gestational carrier”, and “host uterus”. Read through the information under any prenatal care, maternity, obstetrics sections. You will also want to read through the pregnancy specific exclusions and any general exclusions. With your findings you will be able to see just how friendly this insurance is for surrogacy. If you haven’t already, check out my guides on how to evaluate an insurance policy. All the best with your journey!
- How to find the best surrogate friendly insurance
- 4 Types of surrogacy insurance – From great to dismal
- How to check health insurance for surrogate friendliness
- How to find a surrogate friendly insurance policy on the ACA marketplace
