Pregnancy costs can range from a few thousand dollars to tens of thousands of dollars. Costs vary depending on the woman’s age, health status, the type of delivery, and the hospital’s or healthcare provider’s location.
Some women may experience complications during pregnancy that require additional medical care. The cost of treatment for these complications can vary widely depending on the severity and complexity of the condition.
In addition to the medical costs associated with pregnancy and delivery, there may be other costs related to having a baby, such as newborn care, pediatrician visits, and vaccinations.
Because of all these costs, it is essential to have health insurance. If you are pregnant or planning to get pregnant, having a health plan can help ensure you receive the necessary medical care before, during, and after your pregnancy.
7 Health Insurance Options For Pregnant Women
The best health insurance options offer comprehensive maternity coverage, including prenatal care, delivery, and postnatal care. A comprehensive plan will include breastfeeding support, postpartum care, and pediatric care for your baby after birth.
There are several options you can choose from when shopping for health insurance plans.
Employer-sponsored Health Insurance
Employer-sponsored health insurance for pregnant women typically covers prenatal care, delivery, and postpartum care. This type of insurance may also cover complications during pregnancy, such as gestational diabetes or pre-eclampsia.
Employer-sponsored health insurance plans vary in coverage and benefits. So, make sure you review the plan documents carefully to understand what is covered and any limitations or exclusions. Some plans may have deductibles, copayments, or coinsurance that apply to maternity care.
Under the Affordable Care Act (ACA), also known as Obamacare, employers with 50 or more full-time employees must provide affordable health insurance coverage to their full-time employees or face a penalty. The coverage must meet specific minimum standards set by the ACA.
The ACA requires employer-sponsored health insurance plans to cover maternity care as an essential health benefit. Most plans must cover prenatal care, delivery, and postpartum care without cost-sharing, such as deductibles or copayments.
The federal marketplace HealthCare.gov is an online platform where individuals and small businesses can compare and purchase health insurance plans from private insurance companies. Marketplace insurance plans are offered under the Affordable Care Act.
Plans offered on the marketplace typically provide comprehensive health coverage. Still, they are more costly than employer-sponsored insurance or federal health plans.
The marketplace offers different types of metal-tier plans, including Bronze, Silver, Gold, and Platinum plans. These vary in cost-sharing structure and monthly premiums.
Gold health plans are generally considered the best option for pregnant women. This is because they offer the most comprehensive coverage. They typically have higher monthly premiums, but they also offer lower out-of-pocket costs for medical services. This can be particularly helpful for pregnant women, who often require frequent visits to the doctor and may need additional medical benefits.
Gold plans also include prenatal care, delivery, and postpartum care.
To purchase a marketplace insurance plan, individuals must enroll during the annual Open Enrollment period. You can also enroll during the Special Enrollment Period if you have a qualifying life event, such as losing your job or getting married.
The process of finding the right plan for you and signing up through the marketplace can be complicated and confusing. This is where we can help. At Enhance Health, we make the process easy for you. We’ll guide you through the process and talk you through your options. This ensures that you can make an informed decision on which healthcare plan would be best suited for your specific needs.
Medicaid is a government-funded healthcare program for individuals and families with low income and limited resources. Pregnant women who meet the eligibility requirements can receive comprehensive prenatal care, delivery, and postpartum care through Medicaid.
Medicaid for pregnant women covers various services, including:
- prenatal doctor visits
- lab tests
- hospital delivery
It may also cover childbirth education classes, breastfeeding support, and other related services.
Eligibility for Medicaid for pregnant women varies by state. Still, pregnant women with a household income below a certain threshold are generally eligible.
You may be eligible for Full-scope Medicaid depending on your state’s requirements.
Full-scope Medicaid for pregnant women covers a wide range of healthcare services related to pregnancy, childbirth, and postpartum care. This includes:
- prenatal care
- delivery and hospitalization
- physician and midwife services
- laboratory and diagnostic services
- and prescription drugs related to pregnancy
In addition to these basic services, some states may offer additional benefits for pregnant women under their Medicaid programs. These can include dental and vision care, nutritional counseling, smoking cessation programs, and transportation to medical appointments.
If you have full-scope Medicaid coverage at the time of your baby’s birth, your baby will be covered under your Medicaid plan.
In most states, babies born to mothers with Medicaid coverage are automatically eligible for Medicaid for the first year of their life as long as the mother remains eligible for Medicaid. This means that your baby will be able to receive healthcare services, including well-baby checkups, immunizations, and other medical services that are covered under your Medicaid plan.
Pregnant women whose income exceeds the limit for full-scope Medicaid may be eligible for pregnancy-related Medicaid. The income limit varies by state but is generally around 138% of the federal poverty level.
Pregnant women must be legal residents of the state where they apply for Medicaid.
Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program (CHIP) provides healthcare coverage to low-income children and pregnant women who meet the program’s eligibility requirements.
Pregnant women eligible for CHIP can receive prenatal care and other health services to help ensure a healthy pregnancy and delivery. Depending on the state, CHIP may cover the costs of prenatal care, labor and delivery, postpartum care, and other related services.
To be eligible for CHIP as a pregnant woman, you must meet your state’s income requirements and other eligibility criteria, which may vary from state to state.
You can contact your state’s CHIP program to learn more about your area’s coverage and eligibility requirements.
Supplementary Insurance For Pregnancy
Supplemental pregnancy insurance is not a substitute for comprehensive health insurance, which covers various medical services beyond pregnancy-related care. Supplementary coverage is usually an add-on to your regular insurance and provides financial coverage for pregnancy-related expenses.
You may need to meet specific eligibility requirements to qualify for supplementary insurance, such as enrolling in a particular primary insurance plan or meeting specific health criteria.
Hospital Indemnity Insurance
Hospital indemnity insurance can cover childbirth hospitalization expenses, including room and board, surgery, anesthesia, and other related services. Prenatal services are typically not covered by hospital indemnity.
An indemnity plan can provide extra benefits if your baby is born prematurely and needs to be admitted to the neonatal intensive care unit (NICU).
Some policies may provide coverage only for a specific number of days or a fixed dollar amount per day. In contrast, others may provide coverage for the entire hospital stay.
Disability Insurance For Pregnancy
Pregnancy disability insurance (PDI) provides financial protection to women who cannot work due to pregnancy-related medical conditions. PDI benefits typically cover a portion of the woman’s salary or income during the period of disability.
In the United States, some states offer PDI as short-term disability insurance that covers pregnancy-related medical conditions. The eligibility requirements, coverage, and benefits of PDI vary by state. It’s essential to check with your state’s labor department or insurance commissioner for more information.
PDI typically only covers pregnancy-related medical conditions and does not cover the entire pregnancy or maternity leave.
What Health Care Services Are Covered For A Pregnant Woman?
Prenatal care is the healthcare that a woman receives during pregnancy. This includes regular check-ups with an obstetrician or midwife to monitor the health of the mother and the developing fetus.
During these appointments, the healthcare provider may:
- check the mother’s blood pressure, weight, and urine
- listen to the baby’s heartbeat
- perform ultrasounds and other tests to monitor the fetus’s health
Prenatal care is essential for ensuring a healthy pregnancy and delivery.
Ultrasound exams are imaging tests that use sound waves to create images of the fetus. These exams can help detect potential issues, such as congenital disabilities. They can also help estimate the due date.
Most insurance plans cover at least one ultrasound exam during pregnancy, but additional exams may be covered if medically necessary.
Blood tests and other lab tests are often done during prenatal care to monitor the health of the mother and the developing fetus. These tests may include blood tests for anemia, infections, and genetic conditions or disorders.
Delivery And Postpartum Care
Most insurance plans cover the cost of hospital delivery, including anesthesia and other medical interventions. Postpartum care is also covered, including follow-up visits with a healthcare provider. This may include care for the mother’s physical recovery and the newborn’s care.
Many insurance plans cover the cost of lactation counseling and breastfeeding equipment such as breast pumps. This can include assistance with latching, positioning, and other breastfeeding issues.
High-risk Pregnancy Care
If a woman has a high-risk pregnancy, she may need additional tests, treatments, or monitoring. These services may also be covered by insurance.
High-risk pregnancies can include pregnancies in women:
- who are over the age of 35
- have a history of miscarriage
- have a chronic medical condition such as diabetes or high blood pressure
- or are carrying multiples (twins, triplets, etc.)
What To Consider When Choosing Insurance For Pregnant Women
It is generally best to get health insurance before you get pregnant. Most insurance plans have waiting periods before they cover pregnancy-related expenses, such as prenatal care and childbirth.
But, if you are already pregnant and do not have health insurance, you should still explore your options.
Whether you are pregnant or plan to get pregnant in the future, here are several factors to consider when choosing health insurance:
- Coverage for prenatal care. Look for an insurance plan that covers regular check-ups, ultrasounds, and other necessary tests. Choosing an insurance plan that covers prenatal care is essential, as this is crucial for a healthy pregnancy.
- Delivery coverage. Consider whether the insurance plan covers the costs associated with childbirth, such as hospital stays, labor and delivery charges, and anesthesia.
- Network of providers. Check to see if the insurance plan has a network of providers that includes obstetricians, gynecologists, and pediatricians, as well as hospitals and clinics specializing in maternity care. This can help you access quality care throughout your pregnancy and after your baby’s birth.
- Cost. Consider the overall cost of the insurance plan, including premiums, deductibles, and copays. Look for plans that offer discounts or cost-sharing options for maternity care.
- Benefits for newborns. Find out whether the insurance plan covers the costs associated with newborn care, such as well-baby check-ups, immunizations, and hospital stays.
- Pre-existing conditions. If you have a pre-existing medical condition, such as diabetes or high blood pressure, ensure the insurance plan covers the costs of managing these conditions during pregnancy.
Frequently Asked Questions About Health Insurance For Pregnant Women
Can a health plan refuse to let me enroll because I’m pregnant?
A health plan cannot refuse to let you enroll because you are pregnant in the United States. Under the Affordable Care Act, health insurance plans are prohibited from denying coverage or charging higher premiums based on pregnancy or pre-existing conditions.
Additionally, under the ACA, all qualified health plans must cover a range of essential health benefits. This includes maternity and newborn care. If you are pregnant and enrolled in a qualified health plan, you should have prenatal care, delivery, and postpartum care coverage.
However, it is essential to note that not all health plans are qualified health plans. Short-term health plans, for example, may not offer the same coverage for pregnancy and childbirth as a qualified health plan.
Therefore, it is essential to carefully review the details of any health plan and ensure it meets your needs.
Do I qualify for special enrollment for a health plan if I am pregnant?
Pregnancy is not considered a qualifying life event for health insurance special enrollment under the ACA.
However, say you are pregnant and currently uninsured. In that case, you may still be able to enroll in a health insurance plan through a special enrollment period if you experience another qualifying life event. For example, losing your job-based health coverage or getting married.
What preventative care do health plans cover for pregnancy?
Health plans typically cover a range of preventative care services for pregnancy. These services are designed to help ensure the mother’s and developing baby’s health and well-being and may include:
- Prenatal vitamins, such as folic acid, which are essential for your baby’s healthy development.
- Immunizations recommended during pregnancy, such as the flu and Tdap.
- Testing and counseling for sexually transmitted diseases, including HIV
- Testing for a blood condition known as Rh incompatibility
- Screening tests (including gestational diabetes, preeclampsia, and other conditions that can affect the health of the mother and the baby)
- Counseling and education services to help you manage your pregnancy and prepare for childbirth, such as childbirth classes, breastfeeding support, and stress management.
- Dental care as pregnancy can increase the risk of some dental issues.
- Screening and helping to quit tobacco use
What happens after my baby is born?
After your baby is born, you must contact your health insurance provider to add your newborn to your policy. Most health insurance plans require adding your newborn to your policy within a specific time.
For example, say you have a job-based health insurance plan. In this case, you may need to notify your employer or the HR department of your baby’s birth so they can update your coverage. If you have a marketplace plan or Medicaid, you can add your baby to your policy through your state’s health insurance exchange.
Adding a new family member to your health insurance policy may result in a higher monthly premium. Be sure to check with your insurance provider about any changes to your policy and any additional costs you may incur.
Additionally, depending on your specific health insurance plan, you may need to meet specific deductibles or out-of-pocket expenses for your baby’s medical care. Thus, reviewing your policy carefully and understanding any potential costs you may face is essential.
Pregnancy and childbirth should be happy and exciting times. You do not want the experience to be clouded by worrying about the cost of pregnancy healthcare.
Pregnancy involves numerous medical appointments, tests, and procedures, including prenatal care, ultrasounds, blood tests, and childbirth. These medical expenses can add up quickly. And they can be prohibitively expensive without insurance!
Having healthcare insurance during pregnancy ensures you have access to the medical care you need for a healthy pregnancy and delivery. It also helps protect you from the financial burden of unexpected complications or hospital stays.
Insurance coverage can vary widely, and pregnant women need to review their specific insurance plan to understand what services are covered and any potential costs or limitations. Enhance Health is here to help you understand your options and the fine print.
Our knowledgeable, licensed insurance representatives will help you choose the health insurance you need and put your mind at ease.