What Families Need to Know About Insurance, Deductibles, and Global OB Billing When No Baby Was Born Last Year

Even if your family didn’t welcome a new baby last year, it’s still worth checking in on your health insurance. Each year brings resets for things like deductibles and out-of-pocket maximums, and policies can change. Taking a few minutes now can save headaches and money later.

Know Your Coverage

Families often assume that if nothing “major” happened last year, insurance details don’t matter. But coverage rules, costs, and eligibility can shift yearly. Here’s a quick breakdown:

• Medicaid: Usually based on income and state-specific rules. Many families pay little to nothing in premiums, and cost-sharing is minimal or non-existent.

• Private insurance: You likely have monthly premiums, a yearly deductible, coinsurance, and an out-of-pocket maximum. Even without big medical events, it’s good to know where you stand.

Deductibles: Don’t Forget They Reset

A deductible is what you pay out-of-pocket before insurance starts covering most costs.

• Private insurance:

  • Deductibles reset every calendar year.

  • If you didn’t have any big medical bills last year, you probably didn’t reach your deductible. That means you’re starting fresh this year.

  • Families with predictable healthcare needs (like ongoing prescriptions or therapies) may want to plan around a high-deductible plan with a Health Savings Account (HSA) to save tax-free for medical expenses.

• Medicaid:

  • Most states have no deductible, but a few may have small cost-sharing requirements. Double-check your state’s rules, especially if your income has changed.

Out-of-Pocket Maximums: Track What Counts

The out-of-pocket maximum is the most you would pay in a year for covered care. Once reached, insurance pays 100%.

• Private insurance:

  • If last year was quiet medically, you probably didn’t hit your out-of-pocket max. Knowing your max helps with budgeting and planning for unexpected visits or prescriptions.

  • It’s also important for families with recurring medical costs, tracking spending toward this cap can be a financial lifesaver.

• Medicaid:

  • Limits on out-of-pocket costs are usually very low, but check if anything changed for this year.

Global OB Billing: What to Know Even Without a Birth Last Year

Even if you didn’t give birth in 2025, understanding global OB billing practices is useful for future planning and insurance review.

• What it means: Many private insurance plans use a “global” billing structure for maternity care, where prenatal visits, delivery, and postpartum care are billed as a single bundled package.

• Why it matters:

  • This affects how your deductible and out-of-pocket maximum apply. If you have multiple OB visits in one year but no delivery, some visits may count separately toward your deductible rather than being included in a global package.

  • For Medicaid, some states also have bundled payments, so checking coverage for individual prenatal or postpartum visits is still important.

• Tip: Ask your insurance provider how global OB billing works in your plan. Knowing this helps you anticipate costs if a birth occurs later in the year and avoid unexpected bills for services that may not be included in the bundle.

• If you transfer care at any point in your pregnancy, this will impact your billing. Understaning how your insurace will cover your prenatal care through a transfer is helpful.

Connect With Your Insurance

Insurance can be confusing, but calling your provider is often easier than it sounds. Tips for making it smooth:

• Prepare questions in advance: Ask about deductible resets, coinsurance, out-of-pocket maximums, dependent coverage, and global OB billing practices.

• Review prior year’s Explanation of Benefits (EOBs): It helps track what counts toward your deductible or out-of-pocket max.

• Confirm networks: Ensure your preferred providers and pharmacies are still covered.

• Document everything: Note dates, names, and answers in case questions come up later.

Key Takeaways

• Deductibles and out-of-pocket maximums reset yearly, even if no new child was born.

• Global OB billing can affect how maternity care counts toward costs, knowing your plan’s rules is key.

• Staying connected with your insurance can prevent costly surprises.

• Review dependent coverage, preventive care, and cost-sharing each year to stay ahead.

What to do Once Your Baby is Born

In the U.S., a newborn is typically eligible for coverage from birth.

• Most plans require you to enroll the baby within 30–60 days of birth.

• If you miss that window, the baby might have to wait for an open enrollment period or qualify for a special enrollment period (SEP). Contact your insurance for specific instructions.

Make a list of the documents you’ll need (e.g., birth certificate or hospital paperwork, Social Security number when available).