Pregnancy & Health Insurance: How to Get the Right Coverage
Whether you’re pregnant or hoping to get pregnant, one thing is for certain.
Having a baby is an expensive endeavor.
The care you need throughout pregnancy and birth can quickly add up to a five-figure bill without insurance.
For this reason, pregnant women or people looking to get pregnant often plan their health insurance carefully before conceiving.
Even so, not everyone can plan their health insurance choices before becoming pregnant.
Here’s what you need to know about health insurance and pregnancy.
With this information, you can attempt to make the best decisions possible for your family.
Pregnancy is Covered Under Health Insurance
Pregnancy is a pre-existing condition for health insurance.
Thanks to the Affordable Care Act (ACA), that isn’t as big of a deal as it used to be.
Before the ACA passed, health insurers could deny you coverage if you had a pre-existing condition and applied for a plan.
Pregnancy costs weren’t required to be covered, either.
Today, health insurance plans that fall under the ACA cannot deny you coverage due to pregnancy.
These plans must cover essential health benefits, including maternity coverage.
Some plans still exist that don’t follow the ACA rules, such as short-term health insurance.
These plans may deny you coverage if you apply and are pregnant. They may also exclude pregnancy-related costs.
Pregnancy uses many specific terms and timelines that are important for understanding health insurance coverage.
- Prenatal care
- Inpatient services
- Postnatal care
- Newborn care
Read your health insurance plan to understand how each of these types of care is covered by your plan.
Prenatal care is the maternity care you receive before your baby is born.
This care usually checks on and monitors the health of you and the baby.
Prenatal care can include things like checkups, ultrasounds, gestational diabetes screenings and much more.
You usually start doctor visits once you think you’re pregnant. Then, you follow up every few weeks.
As the due date nears, your doctor may request more visits to better monitor the health of both you and the baby.
Inpatient services are the services you receive in the hospital when having your baby.
This care includes the costs of delivering your baby by vaginal or cesarean section delivery.
It also includes the doctors’ fees for any doctors that see you or your baby in the hospital.
Postnatal care includes any care for you and your baby for the first six weeks after birth.
The baby is covered under your plan for the first 30 days of its life, as described in the next section.
You are covered as long as you continue having health insurance.
After your baby is born, the care for you and your baby eventually separates.
The Affordable Care Act allows the baby to be considered a part of you for the first 30 days of its life.
This means the coverage falls under your health insurance as if it was provided to you.
The baby will count as part of your deductible during this time.
This treatment doesn’t last forever.
Care for your baby as an extension of you ends 31 days after birth.
The good news:
Having a baby is a qualifying life event. This lets you make health insurance plan changes to add the baby.
You can add them to your current health insurance policy, if possible, or get coverage for them elsewhere.
When you do this, they may have a separate deductible if you have not yet met the family deductible limit.
With the cost of pregnancy, you may very well have already met this limit.
Should You Upgrade Coverage for Pregnancy?
If you’re already pregnant or trying to get pregnant, you may wonder if you should upgrade your coverage.
Pregnancy is a significant medical expense, so it makes sense to ask this question.
If you’re already pregnant and have the option to switch plans, it may make sense.
Look at the costs associated with the plans.
Add up the total costs to find the one that offers the most complete and cheapest coverage for your entire pregnancy and other medical expenses.
Affordable Care Act-compliant plans should have information about pregnancy costs under that plan’s information to help you decide.
People looking to get pregnant may want to switch plans in anticipation of pregnancy costs.
It’s important to remember getting pregnant may not be easy or guaranteed.
If you switch plans early and don’t get pregnant, you may end up paying more for health insurance.
Even if you do get pregnant, the costs are spread out over the entire pregnancy.
Typically, most of the costs come at the end with the hospital bills, though.
When you can sign up for health insurance
Unfortunately, you can’t switch health insurance plans whenever you want.
You can only change your health insurance coverage are certain times. Here’s what you need to know.
First, you can change plans during open enrollment. This is usually toward the end of a year in November or December.
The changes you make usually take effect on January 1 of the following year.
The other option to change health insurance mid-year is called a special enrollment period.
If you have a qualifying life event, you can switch plans for a limited time surrounding that event.
You may qualify for a special enrollment period if you:
- Lose of healthcare coverage
- Have a change in your household
- Have a change in your residence
- Have other qualifying events
You can learn more at Healthcare.gov.
Health Insurance Options
When you’re pregnant or considering getting pregnant, you may want to reconsider your health insurance coverage options.
These are the main options available to obtain health insurance.
If you don’t have health insurance, consider looking into Medicaid.
Medicaid is free or low-cost healthcare.
You may have to pay some out of pocket costs for visits, but Medicaid is much more affordable than traditional insurance.
Medicaid covers the medical care pregnant women will need.
Medicaid coverage may be available to low-income people and certain other groups, including pregnant women.
The rules for qualifying for Medicaid vary from state to state.
Check your state’s Medicaid rules to see if you qualify.
Workplace health insurance plans
If you’re employed, your employer may offer one or several health insurance plans.
Your employer may pay for part or all of the premiums associated with these plans. This may make them cheaper than alternatives.
Your coverage is tied to staying employed with your employer. If you leave your job, you could lose coverage.
That said, some plans offer COBRA coverage. This offers the option to stay on your plan after you leave your job.
If this is the case, you have to pay the full cost after you leave your job.
The employer doesn’t have to subsidize COBRA coverage, so it is often much more expensive than you paid as an employee.
This may extend for up to 18 months or more after you leave your job.
Health insurance marketplace plans
People that want to buy health insurance coverage outside of an employer usually turn to healthcare marketplaces.
Each state either has its own marketplace or uses Healthcare.gov.
You can sign up for coverage on the marketplaces during open enrollment or special enrollment periods if you qualify.
The marketplaces can help you determine if you’ll qualify for a tax credit to help subsidize the cost of these plans.
They also share all of the relevant information about the marketplace plans in one place.
This is important so you can make an informed decision of which plan is best for your family.
Children’s Health Insurance Program (CHIP)
The children’s health insurance program (CHIP) is a state-run program that varies from state to state.
In general, this program is used to insure children whose parents make too much money to qualify for Medicaid but do not have health insurance.
Some states extend this coverage to pregnant women. Check with your state to learn more about this possibility.
What Happens If You Lose Coverage During Pregnancy?
If you lose health insurance coverage during pregnancy, it usually qualifies as a qualifying life event.
This gives you a special enrollment period to purchase a new health insurance plan outside of the open enrollment period.
If you get a new job, you may get health insurance through that job.
If not, you can view and sign up for plans on your state’s marketplace or Healthcare.gov.
Medicaid or CHIP may also be options, depending on your situation.
Consult an Expert
Health coverage isn’t easy to understand. If you need help deciphering healthcare coverage, you have a few options.
If you get coverage through work, contact your human resources or benefits department for general questions.
Specific questions may be best answered by your health insurance company.
People looking to purchase coverage outside of work may want to turn to the healthcare marketplace.
However, this can be frustrating if you can’t find what you’re looking for.
In these cases, you may want to consult a health insurance broker.
Brokers can help you sign up for new plans.
They should be able to answer questions about those plans before you sign up.
They get paid on commission, so make sure you verify what you purchase is in your best interests before buying a health insurance plan.