Proposed ACA Rule Could Raise Out-of-Pocket Costs

- Before the Affordable Care Act (ACA), only 12% of health plans on the individual market covered maternity benefits, and insurers could deny coverage for preexisting conditions like pregnancy or a prior C-section. The ACA established maternity and newborn care as one of ten essential health benefits required in most individual and small-group plans. - The proposed rule would expand eligibility for catastrophic plans, which were previously limited to people under 30 or those with a hardship exemption. While these plans have lower premiums, they come with very high deductibles that must be met before most services are covered. - For 2024, the federally-set out-of-pocket maximums for ACA-compliant plans are $9,450 for an individual and $18,900 for a family. The proposed changes could create catastrophic plans with out-of-pocket limits as high as $15,600 for an individual and $27,600 for a family. - Research shows that even with current insurance, pregnancy and delivery already create a high risk for catastrophic health expenditures for families. For low-income families, public insurance like Medicaid has been shown to be more protective against high out-of-pocket costs than private insurance. - The ACA mandates that preventive services, including prenatal screenings for gestational diabetes, anemia, and other potential complications, be covered without cost-sharing. Catastrophic plans also cover preventive care, but coverage for the birth itself would be subject to the high deductible. - Prior to the ACA, insurers commonly engaged in "gender rating," charging women higher premiums than men for identical plans. The law banned this practice and also required coverage for services like lactation support and breast pumps.