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How to Understand Your Coverage When You Are Expecting

Pregnant couple in their nursery on a laptop

If you are expecting a baby, you will naturally want to know what your health plan will cover. Under the Affordable Care Act of 2014, maternity coverage must be provided by all health plans offered to individuals, families, and small groups. Coverage is mandatory for pregnancy, labor, delivery, and newborn care.

What Changed About Maternity Coverage with the Affordable Care Act?

Before the Affordable Care Act (ACA) was passed in 2014, only nine states required maternity coverage and only approximately 12% of health plans in the individual market included maternity coverage as a benefit. For other plans, it had to be added as a special rider. In addition, pregnancy was treated as a pre-existing condition, so maternity coverage either cost more or was not available to women who were pregnant when they enrolled.

Now, women in the U.S. are guaranteed access to maternity coverage. All major medical health insurance plans cover pregnancy and childbirth as one of the ten essential mandatory health benefits required under the ACA

What Services Are Covered for Expectant Mothers and Babies?

Maternity healthcare services covered by ACA plans include:

  • Newborn baby care
  • Outpatient services: These include doctor visits (prenatal and postnatal), gestational diabetes screenings, lab work, medications, and other services.
  • Inpatient services: Hospitalization, including physician fees.
  • Lactation counseling and lactation devices (breast pumps)

When Can You Enroll in a Health Plan to Cover Maternity?

The Open Enrollment Period begins on November 15 of every year. You can always enroll in a plan or change health plans during this period. Certain qualifying events will trigger a 60-day special enrollment period outside of Open Enrollment during which you can enroll in a plan or switch plans. Becoming pregnant is not such a qualifying event, but the birth of your child is. Once your baby is born, you, your spouse, and your children can enroll in or change your health plan.

How Can I Find Out What Benefits My Plan Covers During Pregnancy?

Every health plan is required to provide their members with Summary of Benefits and Coverage documents. These documents will tell you specifically how your plan covers the costs of pregnancy and childbirth. If you are planning on becoming pregnant or already pregnant, it may be wise to review this information to find out how your health plan compares to others for maternity coverage, and to know what to expect in terms of medical bills with the birth of your child.

Even if you were pregnant before your coverage started, bear in mind that maternity services are covered by all major medical plans. However, if you have a grandfathered individual health plan (one that was purchased individually – not through an employer), it may not cover maternity care. You may want to contact your insurance company to find out.

If you are expecting a baby, you need a health plan that covers your pregnancy, labor, delivery, and care of your newborn. Contact our friendly agent for help finding a health insurance plan that meets your needs.

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