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Covered California: Plans cover 'essential' services like maternity

October 3, 2013 12:00:00 AM PDT
When it comes to health insurance, we all know you get what you pay for. But new rules are helping level the playing field for consumers, especially when it comes to key areas of care. Covered California: What you need to know

Baby Daniel is just five days old and while he's a joy, being a first time mom is a huge adjustment for Patama Garcia.

"I have all the support and yet it's still very difficult. It's the breastfeeding that takes up most of our energy and time in the day," said Garcia.

Breastfeeding is something Patama really wants to do for her son, but since she's a working mom, she needs lactation counseling, equipment and supplies. And that can run a new parent hundreds of dollars. Pediatric experts say in the long run, it's a good investment.

"Good supportive breastfeeding will save billions of dollars in this country," said Dr. Robert Riewerts at Kaiser Permanente Baldwin Hills.

Industry analysts say only 31 percent of health plans today cover maternity and newborn care services, such as lactation counseling.

But starting Jan. 1, all Covered California health care plans will have to cover it and nine other health categories identified as "essential."

Although health insurance provided through large employers is not required to feature these essential benefits, experts expect these insurers to follow.

"Since each health plan has to offer the same benefits, a consumer doesn't have to worry about which plan offers the best benefits," said John Molina, chief financial officer of Molina Health Care.

Molina says consumers can just focus on whether or not their doctor or hospital is in the network and what the cost is.

Other essential health care includes emergency services, hospitalization, mental health and substance abuse, prescription drugs and preventive and wellness services, like mammography. They're services that will now be available to everyone, regardless of your insurance plan.

Patama's current Kaiser Permanente plan covers the cost of her pump, supplies and lactation counseling. It gives her the encouragement she needs.

"I think if we did get all of this support, we probably would have given up by now and used formula," said Patama. Other essential care benefits include coverage for outpatient care, rehabilitative care, treatment for long-term disabilities, lab services and dental and vision for children.

Covered California: What you need to know

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