Health Insurance and Pregnancy

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Health Insurance Pregnancy

Proper prenatal care plays an essential role in helping you have the healthiest pregnancy possible. At the same time, the unfortunate truth is that millions of people in the United States do not have health insurance, meaning they may skip prenatal care or pay hundreds or thousands of dollars out of pocket.

If you’re expecting and don’t have health insurance, don’t wait. Medical care can make all the difference to you and your baby.

Is It Too Late to Get Health Insurance If I’m Already Pregnant?

No. By law, health insurance plans must cover treatment for pre-existing conditions, including pregnancy. An insurance provider can’t deny coverage for your prenatal care or the baby’s birth, and they can’t make your premium payments higher because of your pregnancy.

Before the Affordable Care Act, it was possible for health insurance providers to deny coverage or charge you extra if you were pregnant when you signed on to the plan. Now, however, your pregnancy coverage is legally protected, including if you sign up for a Medicaid and CHIP plan, so take advantage of it!

How Do I Get Health Insurance?

Starting with your employer, if you can, is often the cheapest way to get health insurance, since your employer may cover part of the premium as a workplace benefit. You can also take a look at options in the health insurance Marketplace.

If the Open Enrollment Period is closed, you can only get coverage through a Marketplace exchange if you qualify for a Special Enrollment Period. Surprisingly, pregnancy doesn’t count as a qualifying life event. Marriage, divorce or legal separation that causes you to lose coverage, some household moves, or loss of health insurance coverage in the past (or upcoming) 60 days do qualify you, so double-check your options if your life is changing in other ways than pregnancy.

Having your baby does qualify you for a Special Enrollment Period. You have 60 days from your baby’s birth to enroll, and you’ll be able to start coverage on the day of your baby’s birth (or adoption).

What’s Covered by Health Insurance?

Just because you’re guaranteed coverage doesn’t mean it’ll be exactly the same across the board. That’s why, whenever possible, you should compare options and select an affordable plan that covers as much of your pregnancy and birth care needs as possible.

All plans (except some grandfathered plans in existence before March 23, 2010) must provide preventive care services. You can expect insurance to cover medically recommended prenatal tests, blood screenings, gestational diabetes testing, prescription folic acid supplements, and labor and delivery costs, including the hospital stay. You’re also legally entitled to breastfeeding equipment through your insurance, although different carriers may have different options for which breast pumps they will cover.

Some insurance providers may cover additional services as well. If you plan to hire a doula to provide labor support, for example, look for a provider that may cover all or part of the fee. Some health insurance plans may also cover all or part of the cost of prenatal massage, if it meets their requirements (such as a prescription from your doctor, or a massage that is part of chiropractic care).

What Should I Ask an Insurance Provider?

Speaking with a representative can help you understand a health insurance plan better. Make sure to get answers to all your questions, including:

  • How much will my deductible be? How much will monthly premiums and copays cost?
  • Which prenatal and maternity services are covered? Which are not?
  • What’s the process to add my baby to the plan, once he or she is born?
  • Which providers near me are in the plan’s network?
  • What birthing tools are covered (birth ball, renting a water birth pool, etc.)?
  • What coverage do you offer for breast pumps, lactation consultant services, and other breastfeeding supplies and services?
  • What coverage options exist for midwife or doula support?

Securing coverage provides peace of mind and makes it easier to get the medical care you need for a happy, healthy pregnancy and baby.

Jessica Sillers
Jessica Sillers is a parenting and finance writer whose work has been featured in Pregnancy & Newborn, Headspace, and more. As a new mom herself, she’s passionate about helping other parents find the community and support they need. When she’s not writing, she loves spending time with her family, reading, and hiking.

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