Whether you are planning children into your future, are pregnant, or have recently given birth, having a health insurance policy is crucial for managing the planned and unexpected medical costs for you and your baby. Pregnancy and newborn care can be expensive. However, health insurance coverage enables you to participate in prenatal and postnatal care, reducing your risk of complications during pregnancy. Let’s look at the health insurance plans that offer the best coverage to infants and pregnant women.
What are the Best Health Insurance Plans for Pregnant Women?
Pregnant women should look for health insurance plans that provide adequate coverage for inpatient care, outpatient prenatal care, newborn care, and lactation assistance. Shopping for an individual plan on your state agency website can help you determine your eligibility for government-backed insurance plans or assist you in finding other suitable options.
i) Marketplace Insurance
If you don’t have insurance and want to buy an individual marketplace plan, you’ll need to wait until open enrollment, which starts on November 15th each year. You might be able to apply at any time of the year if you qualify for a Special Enrollment Period (SEP), such as relocating or losing coverage. Pregnancy does not qualify you for a special enrollment; however, the birth of a child does. Also, you can apply for CHIP or Medicaid coverage if you meet specific eligibility requirements for this program.
While marketplace programs typically provide comprehensive health coverage, they are more expensive than employer-sponsored coverage or federal health programs. Marketplace plans provide coverage for all essential healthcare benefits, including maternity services. Meta-tier plans give freedom to the enrollees to choose their service provider and their cost-sharing rates. Gold plans typically provide maximum coverage for pregnant women and are less expensive than platinum plans. Gold plans are best for people who need routine and specialized coverage, a perfect option for a new mom!
If these marketplace plans are out of your price range, keep reading to learn about the differences between employer-sponsored coverage, federal programs, and supplemental insurance plans.
ii) Employer-Sponsored Health Insurance
Employer-sponsored insurance can provide coverage to a pregnant woman under a group policy. According to the ACA act, employers with more than 50 full-time employees must provide health insurance to their full-time workers or full-time equivalent employees. These plans are beneficial if your organization pays a portion of your health insurance premiums, lowering your out-of-pocket expenses. Some employers’ healthcare plans may impose a waiting period before you can take advantage of the benefits to avoid adverse selection—which occurs when sick people apply for insurance only after they become ill.
If you use your parent’s employer health plan for your healthcare, assuming you are below the age of 26 and have become pregnant, or if you have a child on your plan who is under the age of 26 and becomes pregnant, health coverage can get a little more complicated. Adult individuals classified as dependents under an employer’s insurance plan cannot obtain coverage for their children’s pregnancies. In this case, shopping for Medicaid or marketplace coverage would be the best health option.
If you are pregnant and registered in employer-sponsored insurance but then change jobs or leave entirely, you may need to wait before enrolling in the new program. This may not be a problem if you’re early in your pregnancy, but it could be if you’re further along and require more attention. To keep you covered, your organization will typically provide you with information on how to enroll in a COBRA plan when you leave your job. COBRA plan allows you to receive the same pregnancy benefits and necessary healthcare coverage as your previous plan, but it will be more costly.
iii) Medicaid or CHIP Plan
A pregnant woman can sign up for the CHIP and Medicaid programs that provide complimentary or low-cost services to millions of Americans. These programs specifically assist low-income families, children, pregnant women, and newborns in affording medical care. Eligibility for these plans depends on your income, household size, citizenship, and immigration status. The states regulate both Medicaid and CHIP plans, so rules and services may differ depending on your location.
iv) Full-Scope Medicaid Coverage
According to the NHeLP (National Health Law Program), a pregnant woman who meets the state’s requirements is eligible for full-scope Medicaid coverage at any point during her pregnancy.
Assume you have Medicaid coverage at the time of your child’s birth. In that case, your baby will be automatically enrolled in the program and remain eligible for at least one year. If you become eligible during your pregnancy, you’ll get coverage for 60 days after giving birth. However, you may lose your coverage after 60 days. Your state’s CHIP or Medicaid agency will notify you about your coverage end date, so you can sign up for a Marketplace program to avoid a gap in your coverage.
v) Medicaid Health Insurance for Pregnant Women
You may be eligible for pregnancy-related Medicaid even if your household income exceeds the income thresholds for full-scope Medicaid coverage. Women can get Medicaid coverage for “pregnancy-related services” and “conditions that may complicate the pregnancy.” According to NHeLP, states cannot drop the income threshold for this coverage below 133 percent to 185 percent of the FPL (Federal Poverty Level). If you meet specific criteria as a mother, you might be able to increase your child’s Medicaid income eligibility for this coverage.
vi) Children’s Health Insurance Program for Pregnant Women
You can apply for CHIP or Medicaid coverage at any time of the year, not just during Open Enrollment. You have two options: get coverage directly through your state agency or by filling a Marketplace enrollment application and choosing that you want help paying for coverage. If you become eligible during your pregnancy, you’ll get coverage for 60 days after giving birth. After 60 days, you may no longer qualify for coverage, but your child might be. According to the Department of Human and Health Services (HHS), CHIP services vary by state, but they all provide comprehensive coverage, which includes:
- Routine check-ups
- Doctor Visits
- Vision and Dental Care
- Laboratory and X-ray Services
- Inpatient and Outpatient Care
- Emergency Services
The cost of CHIP coverage also varies by state, but it will never exceed 5% of your family’s annual income.
vii) Supplemental Insurance
You should consider supplemental insurance if you are not eligible for healthcare through federal programs, cannot register in a plan, or have a high-risk pregnancy. Supplemental maternity insurance pays you in cash rather than sending payments to your healthcare providers. These programs don’t cover preexisting conditions and these must be purchased before conception. The supplemental plan is provided by indemnity insurance and disability insurance, whereas Medicare has strict eligibility requirements and only covers maternity services under specific Medicare packages.
viii) Medicare Coverage
Typically, Medicare provides coverage to people over 65. But you might get approved for a Medicare plan due to a disability. You would be covered for hospital services during pregnancy or childbirth under Medicare Part A. Medicare Part B would cover doctor visits and outpatient procedures such as lab tests and blood work. Medicare will not cover any services for your baby after your child’s birth.
ix) Short-Term Disability Insurance
Disability insurance may help replace the mother’s income during her maternity leave or be directed by the physician to be on bed rest. Each company has its maternal leave policy, and not every company pays your full wage while on leave or when you extend your vacation. The FMLA (Federal Family Leave Act) only provides 12 weeks of unpaid leave if a physician directs her eligibility criteria.
When you get hired and forget your company’s leave policy, you should clarify these specifics with your employer. If they do not provide you with your full salary during their approved weeks of leave, you may want to consider a hospital indemnity insurance or a short-term disability plan.
Because pregnancy is considered a preexisting condition, you must be enlisted in these plans before conception. Furthermore, these plans would be an excellent option, as they do not cover preexisting medical conditions and are expected to be supplemental insurance.
x) Hospital Indemnity Coverage
Hospital indemnity insurance is helpful for pregnancy and delivery. However, it offers limited coverage for prenatal care. These plans cover all of your expenses for hospitalization and childbirth. These plans are designed to provide coverage for the more extended hospital stay if your child is born prematurely or requires admission to the neonatal intensive care unit (NICU) or intensive care unit (ICU). If you are expecting a high-risk pregnancy or delivery, these low-cost supplemental plans may be worth considering.
xi) Additional Health Insurance Options for Pregnat Women
Examining your local resources may also provide you with some leads on affordable health plans. Specific organizations, such as Planned Parenthood, community health centers, or specific payment programs may exist based on eligibility. Check with your local Planned Parenthood or religious organization to see if they offer any assistance programs. Visit Insurance Shopping and check your eligibility for these programs.
Health Insurance for Maternal and Newborn Care
It is no secret that the high costs of pregnancy care can hinder the excitement of starting a family. But knowing your health coverage options and expected costs can help alleviate this burden. The tricky part is that most medical centers do not offer transparency when estimating the costs associated with childbearing and postnatal care. Prices depend on the state you live in, your health plan enrollment, and, in most cases, the type of birth program, whether that be cesarean delivery or vaginal birth.
You may also experience unanticipated complications during pregnancy or delivery, such as placental problems or gestational diabetes, which will raise your costs. These difficulties are not always in your control, but having access to prenatal care can help reduce the likelihood of these complications and their associated costs.
According to a 2015 case study, of the nearly 137,000 newborns studied, more than 76 percent were born to mothers who experienced at least one pregnancy complication. Costs of these complications varied in severity and price between $988 to $10,287. This suggests that complications are common during pregnancy and that delivery may increase medical care costs for infants immediately following birth.
Health Insurance Coverage for Pregnant Women
According to the Kaiser Family Foundation, most ACA-compliant individual plans, employer-sponsored plans, and marketplace plans cover maternity services such as childbirth and infant care. These plans also cover prenatal screenings and visits, tobacco cessation intervention, folic acid supplements, and breastfeeding services. Copayments are not required for these services because they are considered preventive care. Visit your health insurer’s website for more information on the routine tests commonly performed during pregnancy.
Frequently Asked Questions about Health Insurance Plans for Pregnant Women
For more information on financial planning while pregnant, check out these additional questions:
How do the costs of vaginal birth differ from those of a C-section?
We spoke with Payton Leonard, a Medical Insurance Expert who has been in the insurance industry for a long time. She revealed that C-sections cost approximately $10,000 more than natural vaginal births if the mother is uninsured. While you may prefer the less expensive option, consult with your doctor about their recommendations for the best possible outcome for you and your baby.
Do insurance premium costs increase during or after having a baby?
When shopping around for pregnancy insurance, the prices will depend on your age and current health condition. If you are at risk of developing severe pregnancy complications, your premiums will probably be higher. If you have a history of these complications and believe that you are at risk, in that case, your service provider will cover it, says Nick Schrader of Texas Health Insurance. These factors will increase the cost of your insurance premiums, requiring you to pay more out of pocket. But the law does not permit health insurance companies to increase insurance premiums based on pregnancy.
How much should a mother budget for her baby’s care in the first year, in addition to insurance costs? (For example, hygiene, diapers, lactation, formula, and so on.)
According to Payton Leonard, the range varies for each family depending on household earnings. Still, a mother should budget at least $12,500 per year for all necessities, including health insurance.
Nick Schrader of Texas Health Insurance suggests using government-funded vaccinations to make healthcare more affordable. Also, cloth diapers may be more environmentally friendly and cost-effective than disposable diapers. And, of course, breastfeeding can save you hundreds of dollars compared to formula. Consult with your medical provider about what is best for you and your child.
Here is another piece of advice from Schrader, “pregnancy is already complicated. Don’t add to your stress by worrying about how you’ll pay for the expenses. Get comprehensive insurance coverage so you can concentrate on your delivery and taking care of your newborn.”
Is pregnancy considered a preexisting condition?
Pregnancy is considered a preexisting medical condition. But new legislation requires all marketplace, employer-provided, and Medicaid plans to cover maternity and newborn care. Before this legislation, you might have been denied coverage because of your pregnancy. Pregnancy is now regarded as an essential healthcare benefit that health insurance companies must cover. Here are a few examples of typical pregnancy expenses:
- Weekly doctor’s appointments
- Sonograms and ultrasounds
- OB-GYN (obstetrician and gynecologist) visits
- Delivery Instructions
- Lab work
Typically, hospital costs for pregnancy can be expensive if you do not have health insurance, so finding an affordable policy is critical.
Pregnant women must have health coverage because it protects both the new mother and the developing baby. Furthermore, health insurance coverage reduces the risk of complications during labor or delivery and the costs associated with family planning.
Insurance Shopping assists new and expecting mothers in finding affordable health plans that meet their needs. Signing up takes a few seconds, and the interface is highly user-friendly, without any nuisance or time wasters. So what are you waiting for? Use our services and enroll right away!