Cost-Sharing and Long Episodes of Care: The Impact of Timing of Pregnancy and Delivery on Out-of-Pocket Spending.

Abstract

Affordability of maternity care for commercially insured people is a significant policy challenge. Health insurance plan deductibles and coinsurance percentages typically apply uniformly to individuals for a 12-month "health plan year." Timing of long episodes of care may not align with the health plan year, with implications for patient cost-sharing and affordability. Using detailed enrollment, benefit design, and medical claims data for a commercially insured pregnant population and adjusting for differences in patient demographic and clinical characteristics, we show that delivery timing during a patient's plan year affects their out-of-pocket spending for their maternity episode by as much as 30%. This result is most pronounced for people in high-deductible health plans, who also had higher out-of-pocket spending overall. Ensuring patients do not face additional financial burden if their pregnancy spans two benefit periods, by eliminating or restructuring cost-sharing for maternity care, is one strategy to improve affordability for patients with commercial insurance.