Are Homebirths or Licensed Midwives covered by insurance?
It's common for women to assume that their insurance doesn't cover Midwifery care for a Licensed Midwife. Often I feel this happens because many don't know all the credentialing required, laws governing, and standards Midwives who work out of the hospital are required to have and follow.
Each state is different and a great source to know where Midwifery care is legalized or not is by checking NARM (North American Registry of Midwives).
This site provides lots of information regarding how to become a Midwife, News, Advocacy, and which states are legal/illegal/and a-legal for Midwifery care.
Florida is the state I will refer to since I live and work here and yes we accept insurance. Many birth centers or homebirth Midwives will either have a contract with a private plan (ex. Blue Cross Blue Shield, United Healthcare, etc) or these Midwives will take Medicaid plans (Prestige, Humana, Sunshine, etc). Many times even if the plan doesn't contract with the Midwife they can typically get an authorization from the insurance plan to be authorized for in/out of network.
If the plan authorizes the Midwife for in/out of network then those benefits, co-insurance, co-pays, and deductibles would apply as if you were delivering with an OB who was either in/out of network.
There are a few other options if the Midwife is not contracted with your insurance. Most Midwives will have an insurance coordinator who will work you through this process so it's not so overwhelming for you but they would then look into getting an LOA (letter of agreement) from your plan. This is basically your plan realizing that although no Licensed Midwives are in-network for your zone, financially it would benefit them and sometimes legally they need to provide the option, to agree on a price and contract with that Midwife case by case.
The final option that I'm aware of for moms wanting a Licensed Midwife for their home birth or birthing center birth is to look into a GAP exemption. This option is slightly tricky and I would definitely suggest an insurance coordinator but a great option if all else fails. Basically, a GAP exemption is trying to umbrella Florida's law
Again, plans will always want to refer you to a provider in-network but if not the above options are still available to you.
No isn't always no. Midwives are Licensed by many states and with that typically you can access coverage with your insurance plan.
~Midwife Gelena
Each state is different and a great source to know where Midwifery care is legalized or not is by checking NARM (North American Registry of Midwives).
This site provides lots of information regarding how to become a Midwife, News, Advocacy, and which states are legal/illegal/and a-legal for Midwifery care.
Florida is the state I will refer to since I live and work here and yes we accept insurance. Many birth centers or homebirth Midwives will either have a contract with a private plan (ex. Blue Cross Blue Shield, United Healthcare, etc) or these Midwives will take Medicaid plans (Prestige, Humana, Sunshine, etc). Many times even if the plan doesn't contract with the Midwife they can typically get an authorization from the insurance plan to be authorized for in/out of network.
If the plan authorizes the Midwife for in/out of network then those benefits, co-insurance, co-pays, and deductibles would apply as if you were delivering with an OB who was either in/out of network.
There are a few other options if the Midwife is not contracted with your insurance. Most Midwives will have an insurance coordinator who will work you through this process so it's not so overwhelming for you but they would then look into getting an LOA (letter of agreement) from your plan. This is basically your plan realizing that although no Licensed Midwives are in-network for your zone, financially it would benefit them and sometimes legally they need to provide the option, to agree on a price and contract with that Midwife case by case.
The final option that I'm aware of for moms wanting a Licensed Midwife for their home birth or birthing center birth is to look into a GAP exemption. This option is slightly tricky and I would definitely suggest an insurance coordinator but a great option if all else fails. Basically, a GAP exemption is trying to umbrella Florida's law
“(1) Any group, blanket, or franchise policy of health insurance that provides coverage for maternity care must also cover the services of certified nurse-midwives and midwives licensed pursuant to chapter 467, and the services of birth centers licensed under ss. 383.30–383.335.”
which mandates that women can choose where they want to birth without denying coverage by "GAP"ing it with the fact that maybe one's plan doesn't have Licensed Midwives contracted to refer to their customers.Again, plans will always want to refer you to a provider in-network but if not the above options are still available to you.
No isn't always no. Midwives are Licensed by many states and with that typically you can access coverage with your insurance plan.
~Midwife Gelena
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