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Consumer plans' out-of-pocket maternity costs higher: Study

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A new Kaiser Family Foundation study shows out-of-pocket maternity care costs are higher for families enrolled in consumer-driven health plans.

For example, under traditional health care policies, out-of-pocket costs would total $1,455, or about 15% of allowed charges, for the cost of having a baby, the KFF study found. For health savings account-qualified CDHPs, however, the woman's cost liability could range from $3,000 to $7,000, or 31% to 73% of total allowed charges, the study found.

But CDHP advocates criticized the findings, saying KFF researchers failed to take into account that CDHPs have lower premiums and employers often contribute to accounts used to fund the deductibles.

When added together, the lower premiums and employer contributions to the accounts could offset any additional maternity-related out-of-pocket costs in CDHPs as compared with traditional health plans, they said.

"It seems to me that in doing their analysis, there were two very critical elements of the financial picture that got left out. One is the cost of coverage--the premium costs to the individual or family--as well as the employer contribution to the account," said Meredith Baratz, vp-market solutions for Definity Health, a unit of Minnetonka, Minn.-based UnitedHealth Group and a pioneer in the development of CDHPs.

For example, in the case of pregnant woman enrolled in a CDHP with a $3,000 deductible, with premium savings of approximately $1,000 annually and a $1,600 contribution to the HSA by her employer, a woman would pay only $1,400 out of pocket for maternity costs, which is even less than the average charges in traditional plans cited in the KFF study, Ms. Baratz pointed out.

According to numerous CDHP studies, approximately two-thirds of employers contribute to either health reimbursement arrangements or HSAs, and contributions generally average $1,600, both Ms. Baratz and the KFF study acknowledged.

"They don't mention the offset of premiums," concurred Jay Savan, a principal at Towers Perrin who specializes in development of consumerism initiatives for the consulting practice.