is not a government website and is privately owned. Learn more.

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

Speak to a Health Care Agent
(844) 538-6414
Mon-Fri: 8am-10pm EST
Sat-Sun: 9am-5pm EST TTY users 711
Mon - Fri: 5am - 7pm
Sat - Sun: 5am - 8pm PT

QuoteLab, LLC
700 S. Flower St., Suite 640,
Los Angeles, CA 90017 is operated by Quotelab, LLC, which is an independent broker and is not a federal or state Marketplace website. This website is owned and operated by QuoteLab, LLC, a licensed insurance agency, NPN #19911386. Invitations for application for health insurance on QuoteLab, LLC, only where licensed and appointed. License numbers are available upon request and are provided where required by law. QuoteLab's license information can be found at

Federal Contracting Statement: Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

Third Party Material (TPMO) ( We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

This website may not display all data on Qualified Health Plans being offered in your state through the Marketplace website or the federal Medicare program. This is not a complete listing of plans available in your service area. To see all available data on Qualified Health Plan options in your state, visit your state Marketplace website, go to the Health Insurance Marketplace website at or consult

Submitting this form does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage plan, Medicare Prescription Drug plan, Medicare Supplement Plan, or any other Medicare plan. QuoteLab, LLC is independent of the Medicare program and is neither associated with nor endorsed by The Centers for Medicare & Medicaid Services (CMS) or any other governmental agency.

The plans represented on are Medicare Advantage HMO, PPO and PFFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal. If you are paying Medicare Part B premium, you must continue to pay it to maintain coverage.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Every year, Medicare evaluates plans based on a 5-star rating system.

Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

Based on median Medicare Advantage benefit amounts for dental available across multiple plans and metro areas. Not all benefits available in specific plans or regions.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

[Benefits, premiums and/or copayments/coinsurance] may change on January 1 of each year.

Advertised Pricing:

There are several factors that impact your monthly premium; including your age, geographical location, annual income, dependents, and the type of plan you choose. Monthly premiums do not include out-of-pocket costs.

The advertised price may not be typical. It was generated using the Kaiser Family Foundation's subsidy calculator that was accessed on September 16, 2020. The following parameters were used: 21 year old adult, non-tobacco user, annual income of $24,700 in 2020, no children, and no available coverage through a spouse's employer. The resulting monthly premium was $30 per month (or $360 per year after $2,751 in subsidies) for a Bronze Plan. Even when using the same parameters, the resulting premium and subsidy calculations may be subject to change.