• Erin L Duffy, Samantha Randall, Sarah Green, and Erin Trish.
• USC Schaeffer Center for Health Policy & Economics, 635 Downey Way, VPD 414F, Los Angeles, CA 90089-3333. Email: eld_805@usc.edu.
• Am J Manag Care. 2024 Jun 1; 30 (6): 285288285-288.

ObjectivesThis study explores the concern that annual high-deductible commercial insurance plan design may yield higher out-of-pocket costs when an episode of maternity care spans 2 years, exposing patients to their cost-sharing limits twice during their episode of care.Study DesignCross-sectional study of Health Care Cost Institute commercial claims.MethodsThe study sample comprises 1,379,300 deliveries among high-deductible health plan enrollees in years 2012 through 2021. Patients' mean cost sharing is calculated across all service types for 3 time periods: (1) delivery hospitalization, (2) maternity episode from 40 weeks prior to delivery hospitalization through 12 weeks after discharge, and (3) extended period spanning 3 years from January of the year before delivery through December of the year after delivery.ResultsFor each of the 3 episode measurements, mean out-of-pocket spending is highest among those who deliver in January and declines in each subsequent month until August and September (the delivery months with most pregnancy and postpartum periods within the same year), then flattens for the remainder of the year. Mean cost sharing for the maternity episode was $6308 in January and $4998 in December, a difference of $1310. Patients delivering in January also had mean out-of-pocket costs $1491 greater for delivery hospitalization and $1005 greater over the 3-year period than patients delivering in December.ConclusionsHigher out-of-pocket spending is observed when patients face their cost-sharing limits twice within an episode of maternity care, and this difference persists even when evaluating 3 calendar years of patients' out-of-pocket spending.

20 keywords...

hide…