The Affordable Care Act (ACA) improved health insurance coverage for young adults, but beware of the pregnancy loophole.
The ACA allows young adults up to age 26 can stay on a parent’s health plan. Children up to 26 can go a parent’s plan regardless of whether they live away from home, are out of school or are married.
Affordable Care Act changed pregnancy coverage rules
Most people who have maternity coverage get it through an employer-sponsored plan.
Under the Affordable Care Act, new health plans must cover a wide range of preventive-care services without charging a deductible, copayment or co-insurance.
All individual and small group health plans are required to cover pregnancy and maternity care services, which are part of the so-called 10 “essential benefits.” Among those services are a variety of pregnancy-related screenings, such as testing for gestational diabetes, as well as breastfeeding supplies and support.
Federal law prohibits those plans from denying coverage or charging higher premiums for people with preexisting conditions, including pregnancy.
- Affordable care act ensures that all individual and small group health plans offer coverage for pregnancy, as well as maternity care services.
- According to federal law, there is not the requirement for health plans to offer maternity coverage to dependent children.
- If you are pregnant and do not have coverage for maternity services or childbirth, you can buy a Medicaid or children’s health insurance plan.
- Most people get maternity coverage through an employer-sponsored plan.
Maternity services and childbirth are likely not covered if you’re a dependent
Although job-based health plans must cover pregnancy-related care for employees and their spouses, federal law doesn’t require the plans to extend maternity coverage to dependent children.
So, you’re 25-year-old daughter can be on your health plan, but her child — your grandchild — cannot.
Most employer-sponsored health plans don’t extend coverage to grandchildren unless the employee is their legal guardian.
Consider shopping for a new health plan
Needless to say, the pregnancy loophole can cause major headaches for expectant mothers. If you are pregnant and without coverage for maternity services or childbirth, consider these options:
- An ACA exchanges plan. You can get an individual plan that covers your pregnancy. ACA plans are eligible for cost-saving subsidies based on income.
- A Medicaid or Children’s Health Insurance program plan. This can be an option depending on your income and state. More than three dozen states expanded Medicaid, which raised the income restrictions on Medicaid.
- COBRA could be possible if you or your spouse recently became unemployed.
- Catastrophic health insurance. These plans are available to people under 30. They offer low premiums and comprehensive coverage. However, they have high out-of-pocket costs, which could be a problem during a pregnancy.
- Short-term health plan. These low-cost plans are an option, but make sure to read the fine print. Most short-term plans don’t cover maternity services.
- Once the baby is born, you qualify for a special enrollment period (SEP). This means that after you have your baby you can enroll in a marketplace health plan even if it’s outside the open enrollment period. When you enroll in the new plan, your coverage will be effective from the day the baby was born. Keep in mind that maternity services would not be covered.
Having a baby is costly, so make sure you have the health insurance coverage you need during your pregnancy.