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Health Insurance and Pregnancy

Alvin Nelson
February 5, 2021
Alvin Nelson

health insurance and pregnancy

What Does Health Insurance Cover During Pregnancy?

When searching for quality health insurance plans, pregnancy often arises as a concern. Giving birth to a child can significantly affect health care premiums, co-pays, and deductibles, depending on the type of health insurance.

Most insurance will offer maternity coverage, and, according to the Affordable Care Act's provisions for pre-existing conditions, insurance carriers won't charge pregnant women more for comparable benefits.

This protection against over-charging women is explicitly one of the ACA's most significant contributions to maternity health. Historically, health insurance that covers maternity care wasn't commonplace.

Before the ACA became law, signing up for insurance during pregnancy, even if a woman was unaware of the pregnancy, counted as a pre-existing condition – and she would have to pay higher premiums and deductibles.

In other words, if a pregnant mother applies for health plans after she's already become pregnant, the insurance carrier cannot charge her more than a woman who signed-up for insurance before pregnancy.

The effect has been expanded access to maternity coverage for those who couldn't afford it due to pre-existing condition restrictions or the health plan (i.e., capped lifetime benefits).

But there are still many questions that patients often ask about what maternity coverage entails and what it doesn't.

Here's the most vital information to know about health insurance and pregnancy when looking for coverage.

Do All Private Health Plans Include Pregnancy Coverage?

Before the ACA mandated that all insurance plans include ten essential health benefits, most insurance offered to women didn't have a pregnancy, but now the law is different.

The exception is a so-called "catastrophic plan," and doesn't need maternity coverage since it intends to avert financial catastrophe, not provide holistic health care.

Women used to pay for a separate rider to account for a potential pregnancy, even if they had no real plans to have children soon. They had no other choice but to pay more for the same general benefits.

At that time, only 12 percent of insurance plans for women included pregnancy-related expenses, but the passing of the ACA changed everything for the better.

Today, maternity coverage is a feature all insurance coverage must offer, and patients cannot lose their coverage due to pregnancy, which unfortunately happened to many in previous times.

The caveat is that not every plan offers the same level of benefits, and they can differ substantially concerning premiums, deductibles, and co-pays.

What Type of Maternity Care Is Mandatory?

Mandatory categories of health services for maternity coverage include:

  • Inpatient services
  • Outpatient services
  • Newborn health care

Each category covers various types of health procedures that women may encounter during pregnancy.

For example, inpatient services may include the cost of a hospital stay, including labor, birth, and physician costs.

Outpatient services include prenatal visits to a physician or ongoing care to help new mothers breastfeed correctly.

does health insurance cover pregnancy

The needs of newborns vary widely, but pregnant women can rest easy knowing that the ACA has protected essential care for infants, too.

Does The Health Insurance Marketplace Cover Pregnancy?

The health insurance marketplace on state and federal exchanges (Obamacare), indeed, includes maternity care.

For expectant mothers on an Obamacare plan, there's no co-pay for prenatal trips to the doctor, and pregnant women also don't need a referral from a primary care physician to see an obstetrician-gynecologist.

Plans on the federal exchanges also cover birth control, which was not mandatory before the ACA's passing into law.

How Does The ACA Help Pregnant Women?

The health law protects women's access to health care in several ways.

First, insurance companies cannot drop someone because they get pregnant, which happened to many women before the ACA solidified protections.

Insurance companies also can't force women to pay ongoing out-of-pocket expenses, and they can't set limits on the amount of care they'll cover.

Furthermore, some special situations need clarification.

Do Medicare and Medicaid Cover Pregnancy?

There's no cost-sharing stipulation to receive Medicare or Medicaid when pregnant. If someone qualifies for Medicaid while expecting a child, there won't be very many out-of-pocket expenses, if any.

The confusion occurs when someone doesn't qualify for Medicaid benefits since every state had different criteria.

In this instance, the Children's Health Insurance Program (CHIP) would cover expenses for the child before and shortly after birth.

Typically, CHIP and pregnancy-related Medicaid expires 60 days after the birth, but states have broad discretion in how benefits parcel out.

Does Pregnancy Qualify a Patient For The Special Enrollment Period?

Signing up for health plans on state and federal marketplaces must occur during certain times of the year, most recently in the fall of 2020, to receive subsidized benefits in 2021.

Someone who needs health care outside of the enrollment period must qualify for the special enrollment period.

pregnancy health insurance quotes

Unfortunately, being unexpectedly pregnant doesn't qualify as a significant life event as stipulated in ACA and Medicare policies; however, birthing the child does allow.

This critical distinction has led to much confusion over what maternity care does and doesn't cover.

The bottom line is that insurance carriers still cannot deny coverage based on pregnancy.

This benefit is critical as some pregnant women don't receive proper prenatal medical care because they believe they don't qualify and never sign-up.

Similarly, private insurance companies accept applications during certain times of the year, but they will always work with patients in need.

The catch is that patients will have to apply during the next open enrollment period to sign-up for a health plan on state or federal health insurance marketplaces.

A note: Patients can sign-up for Medicaid benefits any time without the open enrollment requirement.

How To Find Health Insurance Plans For Pregnant Women

The HealthPlans.com platform's benefit is that it streamlines the search for insurance, whether it be on the state and federal marketplaces or through private carriers.

Concerning pregnancy, health insurance can differ substantially from standard plans due to ACA requirements and restrictions.

It's typically a time-consuming process to shop and compare pregnant women's rates in their most delicate time of need.

But by using HealthPlans.com, anyone can find the best insurance for their means after answering a few easy questions and inputting a zip code to find state insurers.

The short interview questions, aimed at finding an affordable plan for everyone, include information like:

  • Birthdate
  • Sex
  • Marital status
  • Tobacco
  • Pre-existing health problems
  • Major life events (e.g., losing a job)

Patients will also need to input an estimate of household income and contact information.

The most significant benefit of using HealthPlans.com is that patients can view a wide selection of plans, fitting their needs financially and medically.

There is no one-size-fits-all health insurance plan, so the platform makes it simple to shop for and compare rates.

HealthPlans.com remains committed to helping pregnant women find the best health care for their children, visit our homepage to compare health insurance plans today.

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