Are You Pregnant or Planning to Be? Check Your Health Insurance Now!

Health insurance is one of those things that you don’t think about much until you need to use it. This is not a good plan if you are pregnant or planning to become pregnant. You need to find out as much as possible now about your health insurance plan so that you don’t make any costly mistakes. If you don’t have health insurance, now is the time to get it.

The average cost to have a baby in the United States, without complications, is $10,808, according to an article in Business Insider.  This price can vary greatly depending on whether you have a vaginal birth or a cesarean section, which is more expensive, and where you live. The article gives the average price for either type of delivery for each state. Other costs before and after the delivery can add several thousand dollars more. Complications for your pregnancy or birth, such as if either you or your baby needing to stay an extra day in the hospital, add to the costs.

If You Have Health Insurance

The good news is that, if you have health insurance, almost all insurance plans offered in the United States must cover maternity services, including prenatal care, the delivery, inpatient care in the hospital, and help with breastfeeding. This mandated coverage is the result of the Affordable Care Act (ACA, also called Obamacare).

If you get your health insurance through your employer or your spouse’s employer, and if the employer has at least 15 people working full-time, the health insurance plans offered must provide maternity services.

However, the amount and the type of services covered may vary greatly from plan to plan. A high deductible plan may require you to pay for all services until you hit the deductible amount, at which time the insurance starts paying. A plan may have a different deductible for each person in a family, which means that you and your baby have to meet separate deductibles after the birth.

Your health insurance plan may require you to use healthcare providers and hospitals or birth centers  that are in its networks. If you use a provider outside the network, you will either pay more or you will have to pay the entire fee for the provider. The network can be complicated to navigate. It is possible that your obstetrician is in-network, but the anesthesiologist who gives you an epidural isn’t, and you will have to pay that fee.

To avoid getting hit with bills that you thought were covered, make sure you understand your insurance plan’s maternity coverage. You should have received a booklet from your health insurer that explains what is covered and what isn’t. The booklet will also have information on deductible amounts and copays. The ACA mandates that there be no copay for prenatal care visits, but there may be copays for other services.

If you get your insurance through your employer, ask the human resources department for help and explanations. You can also call your insurance company to ask for explanations of what is covered and what is not.

Make sure that all your healthcare providers are in your health insurance’s network. Don’t go by what the doctor’s office says about what networks he or she is in because most insurance companies have several plans. Confirm it with the insurance company for your specific plan. Most health insurance companies have a webpage that can help you find doctors and midwives in their network. Also make sure that the hospital or birth center are also within the network.

If You Don’t Have Health Insurance

If you don’t have health insurance, get enrolled in a plan as soon as possible. If you are unemployed or have a low income, you may qualify for Medicaid in your state. Medicaid is a program that provides free or low-cost insurance for people with low income.

As a pregnant woman, in some states, you are also eligible for health coverage through the Children’s Health Insurance Program. This is a program that covers low-cost health coverage to children in families that make too much money to qualify for Medicaid. However, coverage through this program may end shortly after you give birth.

To find health insurance plans for yourself, you can shop for a plan in the Health Insurance Marketplace. You can find information about plans available in your area.

Enroll Your Baby!

Your health insurance will cover your baby’s care for the first 30 days after the birth. But after 30 days, this coverage ends. You have to add your baby to your health insurance plan, which will not happen automatically. If you get your health insurance through your employer or your spouse’s employer, you can ask the human resources department how to enroll your baby in your insurance plans or how to choose a new plan that will include your baby. You can also call your health insurance company for this information.

If you and your spouse do not share the same insurance plan, look for information on which plan gives the better coverage for your child and which has your pediatrician in its network. It may be to your advantage to add your child to your spouse’s plan rather than yours.

Having a baby is what is called a qualifying life event, which means that you don’t have to wait for a special enrollment period to enroll your baby in your health insurance plan. You are also allowed to change your insurance plan at this time.  This special enrollment period only lasts for 60 days after you give birth, so don’t delay in enrolling your baby.

Valerie DeBenedette
Valerie DeBenedette is an experienced health and medical writer who lives about an hour north of New York City with a dog that is smaller than her cat. Her work has appeared in magazines, newspapers, newsletters, and on websites. She is a member of the National Association of Science Writers.

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