Surrogacy Cost and Health Insurance
How to ensure that the gestational carrier’s pregnancy will be covered.
Published by Building Your Family Magazine
By Yifat Shaltiel, Esq.
The total cost of surrogacy can range from $50,000 to more than $100,000, so cost is a key concern when choosing this route. One of the largest variables, and an expense that has seen significant change recently, is health insurance for the gestational surrogate.
Surrogacy health insurance options
It used to be common for insurance providers to restrict or deny maternity coverage for surrogate pregnancies. The Affordable Care Act (ACA) now mandates that maternity care be covered by qualified health insurance plans as an “essential health benefit.” However, non-qualified plans, such as self-funded nonfederal governmental plans, union, and some individual carriers as well as some small group plans, may opt to exclude maternity coverage and/or surrogacy-related maternity care. Some plans may also include language that designates intended parents as the responsible parties for surrogacy-related maternity costs. Therefore, it is important to consult a reproductive law attorney or a qualified insurance broker specializing in insurance for reproductive medicine to review the surrogate’s health plan.
If a surrogate does not have coverage or has a plan that excludes surrogacy, intended parents may opt to pay the full costs of the pregnancy and delivery, may use a financial case manager, or may negotiate rates as self pay with all providers. According to a 2013 study by the Truven Health Analytics, the average cost of a non-complicated pregnancy and delivery without insurance is $22,000. However, the complexity of a pregnancy and delivery cannot be predicted and the medical costs associated with a high risk pregnancy can exceed $100,000.
Intended parents may also purchase surrogacy insurance. These policies can be costly, with premiums of approximately $10,000 and deductibles that can start at $15,000 for a singleton pregnancy and $30,000 for two fetuses.
An alternate and more affordable option is to purchase, through the ACA-based insurance exchanges or private insurance companies, an individual plan that may cover the surrogate’s maternity care. The premiums typically range from $300 to $500 per month. Some plans do not have a deductible and all are mandated to cover certain preventative health services, such as screening for gestational diabetes. Out-of-pocket costs for a pregnancy under an individual plan cannot exceed $6,350 for in-network covered services. However, IPs must not neglect to have these plans reviewed to ensure that there is no language excluding surrogate pregnancies.
Navigating ACA enrollment periods
Individuals can purchase health insurance only during an open enrollment period. The open enrollment period for 2015 runs from November 15, 2014 through February 15, 2015. You may sign up during a non-enrollment period if there is a “Qualifying Life Event,” such as marriage, divorce, the birth or adoption of a child, a move, a change in employment status, or the loss of other health care coverage. Pregnancy is not considered a qualifying life event, so it is important to ensure that proper health insurance is secured prior to proceeding with a surrogate.
Deciding on back-up coverage
Even in cases where a surrogate’s health plan is believed to cover a surrogacy pregnancy, some professionals will recommend that intended parents purchase a secondary, or back-up, insurance policy. These policies provide intended parents with the assurance that the surrogacy-related maternity costs will be covered in the event that the surrogate’s primary insurance provider refuses to pay. Secondary plans can be as costly as surrogacy insurance. If the primary insurance covers everything and the back-up insurance is never used, many of these plans offer a refund of 50 percent or more of their total payment or charge only a minimum premium.