Pregnant women can’t be denied health insurance coverage for being pregnant.
Since the passage of the Affordable Care Act (ACA) over a decade ago, it’s become much easier for pregnant women to get health insurance. Before the ACA, pregnant women were subject to higher insurance rates and could even be denied coverage.
If you’re wondering whether health insurance covers pregnancy, the answer is yes.
Doctors must closely monitor expecting mothers, so having health insurance is extremely important. Pregnancy insurance also covers labor and delivery in a hospital or birthing center, including procedures like cesarean sections.
If you’re currently pregnant or are planning for a baby, it’s important to know what types of pregnancy insurance are best, and how to get health insurance during pregnancy.
- Pregnant women can usually find comprehensive health insurance coverage through their employer or the Affordable Care Act marketplace.
- Prenatal care is a standard part of health insurance plans.
- Becoming pregnant isn’t considered a qualifying life event that allows women to qualify for a special enrollment period. Instead, they may have to wait until open enrollment.
- Depending on their income, women may also be eligible for Medicaid and CHIP (Children’s Health Insurance Program) and can sign up at any time.
What is maternity care coverage?
Maternity insurance coverage is a type of protection that specifically applies to pregnant women, which covers, prenatal, maternity, and newborn care. Every health insurance plan must offer maternity coverage as one of the 10 essential health benefits under the ACA.
Maternity insurance, more commonly called pregnancy insurance, covers many healthcare costs that women typically face during and after pregnancy. Some of the covered services include:
- Routine prenatal and postnatal doctor visits
- Gestational diabetes testing
- Blood work
- Lactation counseling
- Cesarean delivery (C-section)
- Obstetrician fees
- Newborn care
While maternity insurance provides tailored coverage for a pregnant woman, you can’t purchase a specific pregnancy insurance policy. Rather, pregnancy coverage is something that’s automatically included with every health insurance policy under the ACA.
What is the best health insurance for pregnancy?
“The best type of health insurance is always going to be the plan that covers the doctors you want to see,” says Grant Dodge, a licensed health insurance broker with Nevada-based Health Benefits Associates.
Every woman has unique health care needs, so the best insurance for pregnancy is different for everyone. Here are some of the most common health insurance plans available and what they cover:
Health Maintenance Organization (HMO)
With an HMO, you must visit a doctor within the network to use your health insurance coverage. If you see a doctor that’s out-of-network, you’re responsible for paying the entire cost. Most HMO plans require a referral from your primary care doctor to see a specialist.
Preferred Provider Organization (PPO)
A PPO plan covers the cost of in-network care, and you don’t need a referral to see a specialist. You pay a higher out-of-pocket if you want to see a doctor that is out-of-network, but some of the bills will be covered by your insurance.
Exclusive Provider Organization (EPO)
An EPO is similar to an HMO. You have to see a provider in-network. Otherwise, there’s no coverage. However, an EPO plan doesn’t require a referral to see specialists. Typically, EPO plans are less expensive than PPO plans but more expensive than HMOs.
Some health plans are structured with a high-deductible, which comes with a lower monthly premium. But during pregnancy, a high-deductible plan may not be the best option. You could end up paying a lot of money out-of-pocket for pregnancy-related medical care that can be expensive.
Health insurance options for pregnant women
Women who are expecting can purchase health insurance coverage during their pregnancy, but it depends on the circumstances.
Several ways that expecting mothers can purchase pregnancy insurance are:
- Employer-sponsored health insurance
- Individual policy through a private insurance company
- ACA health insurance marketplace
- Federally-funded programs like Medicaid or Children’s Health Insurance Program (CHIP)
If you’re currently uninsured, the only time you can enroll in health insurance while pregnant is during the open enrollment period.
The health insurance marketplace open enrollment is from Nov. 1 to Dec. 15 in most states. Most people get health insurance through their employer. Open enrollment varies by employer, so ask your company’s benefits department about the open enrollment dates.
Getting pregnant isn’t considered a qualifying life event that starts a special enrollment period. However, having a baby is regarded as a qualifying event that creates a special enrollment period when you can sign up for health insurance.
If you become pregnant and are uninsured, you aren’t allowed to purchase health insurance unless your pregnancy coincides with a qualifying event, such as marriage, moving to a new state, or losing coverage through a job.
Meanwhile, Medicaid and CHIP offer low-cost or free health insurance to low-income families, expecting mothers, and children. If you meet the requirements for either program, you can enroll at any point during the year. You don’t need to wait for open enrollment and you’ll be covered until 60 days after giving birth.
If you can’t purchase maternity health insurance during pregnancy, there are a few alternatives. Some women’s health clinics and community health centers provide low-cost medical care through the Hill-Burton Program, which is based on income. Similarly, most Planned Parenthood clinics offer more affordable care for pregnant women.
How to get pregnancy insurance
You can only apply for a new pregnancy insurance policy during the open enrollment period unless you experience a qualifying life event, in which case you can enroll through a special enrollment period.
Before you buy pregnancy insurance, you need to decide what type of plan you want and how to purchase it. This really comes down to what kinds of insurance you can qualify for, which one is the most budget-friendly, and which one has the best coverage.
If you’re a full-time employee with access to health benefits, talk to your employer and see what coverage their plan offers for pregnancy. You can also compare plans through the ACA marketplace.
Once you find a health insurance plan that meets your needs, the enrollment process is usually pretty simple. You’ll select your health plan, add dependents if you have any, and choose the date you want your coverage to start.
If you enroll in your employer’s group health insurance plan, the premiums are typically deducted from your paycheck. If you enroll in coverage through the ACA marketplace or buy an individual plan through a private provider, you usually receive a monthly billing statement for the amount you owe.
Is pregnancy a pre-existing condition?
No, pregnancy isn’t considered a pre-existing condition for insurance. It was once considered a pre-existing condition, but the ACA changed that.
Dodge says health insurance companies aren’t allowed to charge more for health insurance or deny coverage if you’re pregnant. This also goes for a pregnancy pre-existing condition, like gestational diabetes or preeclampsia.
In addition, newborn babies who are enrolled in health insurance within 30 days can’t be denied coverage. The same rule applies to newly adopted children and children who are up for adoption.
What is supplemental insurance for pregnancy?
Health insurance for pregnant women can also include supplemental insurance, and there are two main types — short-term disability insurance and hospital indemnity insurance. Here’s how these supplemental plans work:
- Short-term disability insurance: Many employers offer short-term disability insurance, which provides income replacement during maternity leave and if the mother is placed on bed rest before birth. You can also purchase private disability insurance if you are unemployed or if your company doesn’t offer it.
- Hospital indemnity insurance: Hospital indemnity insurance pays for the cost of delivery, including hospital admission, medications, and emergency surgery. It may also pay for newborn care if the baby is born prematurely or needs to spend time in the intensive care unit. Hospital indemnity insurance can be a good option if you can’t purchase a full health insurance policy before giving birth.
Although supplemental maternity insurance plans can be beneficial, there are some downsides. Notably, you have to purchase both short-term disability and hospital indemnity insurance before you get pregnant to use the coverage. And if you suffer from pre-existing conditions, hospital indemnity plans may not cover treatment related to your condition.
Frequently Asked Questions
Does Medicare cover pregnancy?
Yes, Medicare includes maternity coverage. You can qualify for Medicare before age 65 if you have a qualifying disability.
Original Medicare Part A covers your hospital stay and the cost of delivery, and Part B covers the doctor visits, outpatient treatment, and tests during pregnancy. If you have Medicare Advantage, pregnancy-related costs are covered under Part C.
If you have Medicare and another health insurance plan, such as COBRA benefits or an individual plan, Medicare typically pays first, and the second plan pays the leftover amount.
Does Obamacare cover pregnancy?
Obamacare, which is the less formal name for the Affordable Care Act (ACA), covers pregnancy. Every Obamacare health insurance plan includes maternity coverage as one of the 10 essential health benefits, even if you have pre-existing conditions.
Can you switch insurance during pregnancy?
Switching insurance during pregnancy is possible.
“You can switch insurance plans any time during the open enrollment, or at any point if you have a qualifying life event, regardless of whether or not you are pregnant,” says Dodge.
He also mentions that pregnant women may want to consider switching to a health insurance plan with a lower deductible or higher coverage for hospitalization if they’re able to switch plans before giving birth. This will help lower your out-of-pocket costs.
Does insurance cover surrogate pregnancy?
Health insurance typically doesn’t cover surrogates leading up to birth. Additionally, insurance carriers usually don’t cover fertility treatments, like in-vitro fertilization (IVF) or fertility medications.
If you’re an intended parent who is using a surrogate, the surrogate’s own health insurance policy should cover her during pregnancy. However, the rules around health insurance and surrogacy vary based on the insurance company, so it’s a good idea for you and your surrogate to ask your respective insurance companies about what’s covered.
Will short-term insurance cover pregnancy?
Short-term health insurance plans treat pregnancy as a pre-existing condition. Short-term plans don’t adhere to ACA guidelines, so it’s unlikely that you can get approved for coverage if you’re expecting.
If you get pregnant while you have short-term insurance, most of your medical costs would not be covered.
Does Medicaid or CHIP cover pregnancies?
Yes, state Medicaid and the Children’s Health Insurance Program (CHIP) cover expectant mothers, if they qualify.
State eligibility for these programs vary. Some states incorporate the CHIP program in Medicaid coverage, while others treat them as two separate programs.
Check with your state to find out if you qualify for those programs, which offer comprehensive health coverage at free or low cost.