PARENTING:HAVING A baby can be an expensive time. Buggies, prams, cots and car seats can be a significant drain on your resources, while depending on what care option you opt for, the cost of actually having the baby can run into several thousands of euro. In general, women in Ireland have three main options when it comes to choosing what kind of care they would like – or can afford – during their pregnancy, writes FIONA REDDAN
Public care
First up is public care, which is open to all, as every woman in Ireland is guaranteed the right to free maternity care, regardless of whether they hold health insurance or have a medical card. There are a number of different ways to avail of public care, such as attending the maternity hospital for all appointments, opting for combined care whereby a GP takes some of the appointments, or attending a midwives’ clinic.
As a public patient, you won’t have to pay anything for your antenatal appointments, delivery and hospital accommodation. However, many women who opt for public care avail of a scan in a private clinic, rather than waiting until 20 weeks for their first scan as is the case in many public hospitals.
Numerous facilities are now available around the State, such as Ultrasound Dimensions in Blackrock, Dublin, which charges €145 for an early dating scan, and €195 for a 3D/4D scan, while an early scan will cost €160 at Mount Carmel Hospital.
Private care
If you decide to get private maternity care, you can expect to see your own consultant at each antenatal visit in his or her rooms, and get private accommodation after the birth, depending on availability. Unless you have a lot of money to spend, the private alternative is really only suited to those with private health insurance, as this covers the cost of private accommodation in public hospitals, as well as delivery charges.
However, the cost of consultants’ fees are not included and must be paid for by the patient. In Dublin, fees generally range from about €3,500 to €5,000, while you could knock about €1,000 off if outside the capital.
Although health insurance doesn’t cover these fees in full, most policies offer some form of contribution. At the VHI, both plan A and plan B include a contribution of €255 towards pre- and postnatal, GP, consultant or midwife fees, while €385 is granted on plan B options.
Under Quinn’s Essential Plus policy, you can claim €400 per pregnancy back on the cost of your fees, and up to €500 under Healthmanager. At Hibernian Health, its I Plan, level 2 offers €400 back.
However, it should be noted that some of these contributions are subject to an outpatient excess. For example, at Hibernian Health, the I Plan, level 2 is subject to an excess of €150, while Quinn’s Essential Plus has an excess of €220 for an individual policy, or €440 for a family policy, which means that monies up to these levels must be covered by the member themselves, with insurance cover only kicking in after these amounts are reached.
And, regardless of the level of private health insurance cover you may have, the degree to which you can offset the cost of consultant fees against your insurance policy is limited. For example, premium policies such as the VHI’s Plan E and Hibernian Health’s I Plan, level 5, only offer relatively little recompense – €385 and €400 respectively.
A better bet is Quinn’s top-of-the-range product, Healthmanager Gold, which allows you to claim back €750 against your outpatient maternity consultations.
In addition to the contribution from your health insurer, you can also get a tax rebate on the fees, although following the last Budget, going down the private route has just become a lot more expensive. From this year onwards, you can no longer claim medical expenses back at the higher rate of 41 per cent and even if you are paying tax at the higher rate, the most you can claim back is 20 per cent.
In summary, a member of the VHI’s plan B scheme could expect private maternity care in a public hospital, based on consultant fees of €3,500, to cost them about €2,596, after insurance and tax deductions. By comparison, the cost to the patient last year would only have been €1,330.45, due to the more generous tax relief.
Private in a private hospital
At present, there is only one private maternity hospital in Ireland, Mount Carmel, although the Beacon Hospital is said to be looking at adding a maternity and children’s hospital to its premises in south Dublin.
Private care in a private hospital is the most expensive option as, unlike public hospitals, health insurers don’t cover the costs of hospital care in full, leaving a significant shortfall for the patient, which must be paid in addition to consultants’ fees.
For example, at Mount Carmel, fees for a normal delivery in a private room, including delivery and anaethesist fees, cost €6,095 for three nights. But you will only get a contribution from your health insurer towards these costs. For example at the VHI, you will get a contribution of €2,275 towards charges under plan A, €3,150 under plan B, and €3,400 under plan E.
Quinn offers a rebate of up to €3,500 under Healthmanager, €3,900 under Healthmanager Gold and this rises to €4,000 under Essential Plus.
If you are a member of Hibernian Health, you can claim €3,450 back towards the cost of Mount Carmel if you have I Plan, level 2, and €3,850 if you have level 5.
So, for a patient with Hibernian’s level 2 scheme, a three-night stay in Mount Carmel will cost €2,645. When consultant fees of €3,500 are included, the total cost comes up to more than €6,000, which means that after claiming against tax and including the insurance contribution towards consultancy fees, the patient will be required to pay €4,596 out of their own pocket.
Semi-private
In some hospitals, a semi-private option is also available. Like private care, women see a doctor at each visit, but it may be a member of the consultant’s team, rather than the same consultant all the time, and the person may differ from visit to visit.
As a semi-private patient, you will be entitled to a semi-private room during your stay in hospital, but it may depend on availability, while the number of patients in the room may also vary depending on how busy the hospital is.
At the Coombe Hospital in Dublin, the semi-private fee is €750, while at the National Maternity Hospital (NMH) it costs €500.
At Mount Carmel, a semi-private option is also available, but as in the case of going private there, insurers will only make a contribution towards costs, and the patient must still pay to see a private consultant. The price of a semi-private room for three nights is €5,520.
As is the case with private care, the cost of going semi-private can be offset by the contribution from your insurer, if you have insurance cover. So, if you are a member of Quinn’s Essential Plus scheme, for example, you can claim €400 back, which means that the cost to you of your care in the Coombe will be €350.
You can then claim this expense against your tax but, as previously mentioned, the amount which can be claimed back has decreased from 41 per cent to 20 per cent, which will bring costs down to about €280.
Additional expenses
Private and semi-private patients can also expect to pay additional fees for procedures such as ultrasound scans and blood tests. While the patient may receive mini-scans in the consultant’s rooms, larger scans must be paid for. For example at the Coombe, scans cost €100 each up to a maximum of €300, while at the NMH, the charge is €110 per scan and €105 for blood tests.
While your insurance policy may cover some of the charges, it won’t cover all. For example, at the NMH, the VHI covers the cost of blood tests, but customers of both Quinn and Hibernian must pay about half the cost themselves.
Private patients at Mount Carmel also have to pay extra for certain services. Attendees at the Landscape Clinic, where some Mount Carmel obstetricians have their rooms, will have to pay €540 for a package which includes three scans, and €900 if expecting twins.
Alternatives
In addition to the three main options, other alternatives are also available, depending on where you live. For example, the Southern Health Area currently provides a free homebirth service for women who are eligible and living in counties Cork and Kerry.
Elsewhere, you can expect to pay from €2,000 to €5,000 for the services of an independent midwife, although the HSE also provides a grant, which will defray the costs somewhat. In addition, if you have private health insurance, you will also get a significant contribution towards the costs. For example, Quinn’s Essential Plus offers a grant of up to €4,000 for the cost of the birth, while the VHI’s plan B offers cover up to €3,150, and Hibernian Health’s I Plan, level 2, contributes up to €3,450.
Ensuring you’re insured
Finally, as maternity care is liable to insurance waiting periods, factor this into your decision before committing to a certain type of care. For example, if you decide to upgrade your existing private health insurance cover to get more maternity benefits, you will have to wait a year until your insurer will offer you the additional maternity benefits.
Similarly, if you are taking out private cover for the first time, or it has been more than 13 weeks since you last had private cover, then a 52-week waiting period for maternity benefits will also apply.
On the plus side, all three private insurers provide free cover for newborn babies until the next renewal date.
Next week:Sheila Wayman looks at how much children really cost to rear
