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Health Insurance for Pregnant Women (Can You Get It?) – Forbes Advisor

Health Insurance for Pregnant Women (Can You Get It?)
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Doctors closely monitor women during pregnancy, which leads to most expecting mothers visiting their OB-GYN about 15 times over the course of a full-term pregnancy.

Health insurance covers most of these visits, as well as prenatal tests, ultrasounds, delivery, postpartum care and newborn care.

Pregnant women can’t be denied health insurance for being pregnant, under the Affordable Care Act (ACA). But a pregnancy doesn’t automatically require that insurers cover you. You still must be eligible to buy coverage, such as during an open enrollment period.

Can You Get Health Insurance While Pregnant?

You’re allowed to purchase health insurance at any point during pregnancy as long as you’re eligible to buy coverage at that time. Women can’t be denied health insurance or charged more for coverage due to pregnancy.

You can typically only buy health insurance coverage during an open enrollment period. For Affordable Care Act (ACA) plans, open enrollment is every year from November 1 to January 15 in most states. Employers set their own open enrollment periods.

A pregnancy doesn’t automatically start a special enrollment period in most states, so you want to be sure you have already purchased health insurance before you become pregnant. You’ll be eligible for a special enrollment period once the child is born, but by then it will be too late to cover labor bills.

There are three ways to get health insurance for pregnant women during an open enrollment period:

  • Enroll in an ACA plan through the health insurance marketplace.
  • Get a health plan through your employer.
  • Buy individual health insurance directly from a health insurance company.

There is a way to get health insurance without an open enrollment period, but many Americans don’t qualify. Medicaid and the Children’s Health Insurance Program (CHIP) let you sign up for coverage whenever you’re eligible. You’re eligible based on your household income, and that varies by state.

Is Pregnancy a Pre-Existing Condition?

The ACA law does not allow health insurance companies to consider pregnancy a pre-existing health condition.

If you enroll in a health insurance plan during pregnancy, health insurance companies can’t refuse to insure you, and insurance companies can’t charge you higher health insurance premiums for being pregnant.

This rule also applies to newborns and newly adopted children. If your baby is born with a medical condition and you enroll them in an ACA health insurance plan within 30 days, they can’t be denied coverage due to their pre-existing condition.

How Much Does It Cost to Have a Baby?

The average cost of having a baby is $18,865 without health insurance and $2,854 with health insurance, according to Peterson-Kaiser Family Foundation Health System Tracker.

The exact cost of having a baby depends on many factors, including the type of delivery, maternal age, pregnancy’s risk factors, your location and whether you have health insurance.

ACA-compliant health insurance plans cover most medical expenses during pregnancy, delivery and after birth. Out-of-pocket costs are much cheaper if you have health insurance.

Average labor costs

What Does Health Insurance Cover for Pregnant Women?

All medical insurance plans purchased on the health insurance marketplace provide “essential benefits” for pregnancy, delivery and postpartum care, including newborn care. Below are some of the pregnancy-related services that health insurance covers.

Pregnancy costs covered

  • Routine doctor visits
  • Ultrasounds
  • Prenatal vitamins, including folic acid
  • Lab testing
  • blood work
  • Screenings for pregnancy-related conditions
  • Smoking cessation programs

Delivery costs covered

  • Vaginal or cesarean birth
  • Hospitalization
  • Epidurals and other forms of pain management
  • Medication for labor induction

Postpartum costs covered

  • Newborn care, including early screenings and vaccines
  • Breastfeeding equipment and support
  • lactation consulting
  • Birth control

What Options Are Available If You Can’t Afford Health Insurance While Pregnant?

There are options if you’re pregnant but can’t afford health insurance through an employer, the ACA marketplace or directly from an insurer.

Medicaid/CHIP

Many low-income pregnant women qualify for Medicaid or CHIP, which are funded by states and the federal government. All state Medicaid programs provide coverage during pregnancy with no cost-sharing. You can take a short quiz on Healthcare.gov to see if you qualify for Medicaid in your state.

Medicaid doesn’t have an open enrollment period, so you can get Medicaid or CHIP at any time of the year if you’re eligible.

If you enroll in health insurance while you’re already pregnant, Medicaid retroactively covers qualifying medical bills. Medicaid pays for pregnancy-related medical expenses incurred within three months prior to enrolling in a plan.

But you must have been eligible for Medicaid during that time to have the services covered.

Non-health insurance options

You might also consider pregnancy care through local organizations. For example, Planned Parenthoodand public health centers like the Hill Burton Program provide free or discounted medical care to eligible pregnant women.

Community health centers, which often offer services in at-risk areas, are also an option for pregnant women who don’t have health insurance.

When Can Pregnant Women Enroll in a Health Insurance Plan?

Pregnant women can enroll in a marketplace health insurance plan during the annual open enrollment period, which typically runs from Nov. 1 through mid-January of the following year in most states. During this time, you can enroll in a new health insurance plan or switch to a different plan within this time.

A pregnancy doesn’t automatically start a special enrollment period in most states, though you’re eligible for that period once the child is born.

Here are options to get health insurance outside the open enrollment period.

Check if your state allows a special enrollment period for pregnant women

Connecticut, Maine, Maryland, New York, New Jersey and Washington DC consider a pregnancy as a qualifying life event, which lets pregnant women sign up for coverage. You otherwise can’t sign up for an ACA plan outside of the open enrollment period.

When you experience a qualifying life event, you’re allowed to enroll in a marketplace health insurance plan within 60 days before and after the event occurs. In addition to childbirth, here are some other qualifying life events that will trigger a special enrollment period:

  • Moving to a new ZIP code or county
  • Getting married or divorced
  • Becoming a US citizen
  • Losing employer-sponsored, individual or student health insurance
  • Losing eligibility for Medicaid or CHIP

How To Find Health Insurance During Pregnancy

Pregnancy and labor can be incredibly expensive, so having health insurance is vital. As you shop for coverage and compare policies, there are a few things you should pay attention to, including the premium, out-of-pocket costs and metal tier (for ACA plans).

First, figure out your health insurance eligibility, including options from your employer and your spouse’s employer. See if you can join an employer’s health plan, which is often more affordable than the ACA marketplace.

Next, look into the ACA marketplace. The ACA marketplace offers plans in four ACA metal tiers: Bronze, Silver, Gold and Platinum health plans. Gold and Platinum plans have the most expensive premiums but the lowest out-of-pocket costs. These might be better plans if you’re pregnant or planning on it for the coming year. Bronze and Silver plans have lower premiums but can be pricey when you need health care, which makes them potentially more expensive for pregnant women in the long run.

A benefit of the ACA marketplace is that the health plans are eligible for advanced premium tax credits. These types of tax credits reduce the cost of ACA health insurance, but you must qualify based on your household income and family size.

When you look for a plan on the ACA marketplace, the website will also let you know if you’re eligible for Medicaid based on your household income. If you’re eligible for Medicaid, that’s a low-cost, comprehensive health insurance option.

No matter which health plan you choose, review the provider networks to make sure your OB-GYN and other providers are in the plan’s provider network. Check if your preferred hospital or birth center is also an in-network facility.

The best way to check whether a provider is in-network is to contact the doctor office or facility and make sure the specific plan is considered in-network. Don’t rely on an insurance company’s provider list on its website. Those lists may be wrong or have outdated information.

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Health Insurance for Pregnant Women FAQs

Why is it important to have health insurance while pregnant?

Having health insurance during pregnancy helps pay for health care and reduces the chances of a pregnancy leading to exorbitant medical debt.

Pregnancy and labor can be expensive. Peterson-Kaiser Family Foundation (KFF) Health System Tracker estimates that the average cost of labor without insurance is $18,865. Without health insurance, you may wind up having to pay all of the health care costs.

Health insurance also helps you get preventive care during pregnancy. Having insurance means you don’t have to worry about paying all the costs for necessary appointments and tests.

Is the baby covered by the same health insurance once born?

Your baby is automatically covered by your health insurance plan for the first 30 days after you give birth, though the coverage may change by having an additional person covered, such as increasing your health insurance deductible. During this time, your health plan will cover your baby’s basic care, such as vaccines, tests and screenings.

You should formally enroll your baby in your health plan within that 30-day period so they have continued coverage.

What can you get free from insurance when pregnant?

There are a variety of things you can get for free during your pregnancy.

All basic prenatal care is free to expecting mothers with an ACA health insurance plan. Most doctor’s visits and tests have no cost sharing, so you pay nothing out-of-pocket, even if you haven’t reached your deductible. Many prenatal vitamins, like folic acid supplements, are also free.

If you’re planning to breastfeed your newborn, Affordable Care Act (ACA) health insurance plans are also required to provide free breastfeeding equipment, such as a breast pump. You also get free breastfeeding support and lactation counseling when you’re postpartum.

Can I add my girlfriend to my health insurance if she is pregnant?

Unless you’re legally married, you usually can’t add a girlfriend to your health insurance plan, even if she is pregnant. The only exception is in states that allow domestic partners to be insured on the same health insurance policy.

If you live in a state where domestic partners can be jointly insured, you can only enroll your girlfriend in your plan if she experiences a qualifying life event. Pregnancy doesn’t count as a qualifying life event in most states.


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