Bringing a new life into the world is an incredible and life-changing experience. However, it also comes with its own set of financial considerations.
Many people wonder if insurance can help with the costs associated with childbirth. This is a question that can have a significant impact on your financial peace of mind during this exciting journey.
Our article explores insurance coverage for childbirth in a way that’s easy to understand, whether you’re an expectant parent, planning to start a family, or just curious about how insurance can play a role in this critical life event.
If you’re going the conventional hospital birth route or are keen on home birth, you’ll find all you need to know right here.
Does Insurance Cover Pregnancy And Childbirth?
Most health insurance covers maternity services and childbirth. All major medical insurance plans on the ACA marketplace, from individual to family and group plans, must cover pregnancy and childbirth. And all new plans subject to the Affordable Care Act’s health reforms will do so.
Plans that were signed up for before the Act didn’t necessarily offer such benefits. But if you sign up for any new health insurance plan under the ACA, you will be covered for maternity and childbirth.
The exact scope of these benefits and coverage differs from one insurance provider or health plan to the next. The details of a health plan can also depend on the state of residence. But despite slight differences, you’ll always be covered for childbirth.
What about other health insurance, like the federal program for low-income individuals and families – Medicaid? The ACA was primarily formulated to expand Medicaid services and shares much in common with it. Thus, Medicaid also offers coverage for pregnancy services and childbirth.
Maternity & Childbirth Under The ACA
Pregnancy and childbirth are listed under the essential benefits that all ACA plans must offer. This applies to all pregnancies, even if they started before your coverage. However, that was not the case before the ACA was signed into law in 2010 or even in the early years after it was introduced.
In the past, maternity coverage wasn’t guaranteed. Only nine states required maternity coverage before 2014. Approximately 12% of individual health insurance plans listed pregnancy as an included benefit.
But times have changed. According to the National Women’s Law Center, ACA plans must now offer breastfeeding benefits like breast pumps. These benefits are available without cost-sharing payments like deductibles, copayments, or coinsurance.
Does Pregnancy Qualify You For Special Enrollment?
You must sign up for ACA plans in the dedicated enrollment period, called Open Enrollment. In most states, this runs from the 1st of November to the 15th of January every year.
But you might be unable to sign up during the period due to a serious accident, death in the family, natural disaster, or another life event. Fortunately, such circumstances make you eligible for special enrollment.
Pregnancy does not qualify you for special enrollment unless you were hospitalized for complications during the open enrollment period. It will be up to you to apply for a special enrollment with proof that you were incapacitated at the time.
However, giving birth does qualify you for special enrollment. If you give birth to your baby outside of the open enrollment period, you should be able to enroll for healthcare coverage under special enrollment.
Are Some Plans Not Required To Cover Childbirth?
Some health insurance plans are not required to cover maternity care. They include “grandfathered” plans and “excepted benefits “plans, as these don’t have to comply with the ACA.
Grandfathered plans are insurance policies started before the ACA took effect on the 23rd of March, 2010. These plans are not ACA-compliant and not sold on the ACA Marketplace.
Excepted benefits plans are not major medical insurance. They are not subject to ACA guidelines as they aim to supplement traditional insurance coverage, with benefits not always offered by conventional medical insurance, like vision and dental care or nursing home care.
Similarly, short-term insurance, travel insurance, a fixed indemnity plan, or other supplemental coverage usually won’t cover maternity and childbirth. If they do, the coverage will be minimal, but always check the details of your specific policy to be sure.
Maternity Services Covered By Health Insurance
You’ll need many different services during maternity. Most are outpatient services before the birth, and some are inpatient services for the delivery. Several services are covered by ACA medical insurance.
Prenatal Visits, Scans, And Screening
Prenatal visits include:
- Blood pressure and weight checks.
- Uterine measurements.
- Ultrasound scans to check fetal development.
They may also include screening for sexually transmitted infections in the mother or genetic abnormalities in the fetus. ACA health plans cover these services.
They may also cover, regardless of deductible status and without copayments of any kind, screening for:
- Gestational diabetes
- Hepatitis B
- RH incompatibility
- Maternal depression
Other services are sometimes available, depending on the specific benefits of your particular plan. Additional screening services may incur extra costs. Only services deemed as essential don’t carry out-of-pocket costs.
This is often categorized as preventive care. Counseling, education, support, and breastfeeding equipment are offered if necessary during lactation.
It may be offered as:
- outpatient care during the last trimester of pregnancy
- inpatient care directly after the birth
- or as an outpatient service for a limited time after the birth and release from the hospital
Birth & Newborn Care
Childbirth, meaning the delivery of a baby, whether by vaginal birth or a C-Section (surgical delivery) is covered by ACA health plans.
However, not all plans cover factors like epidural anesthesia and other pain-relieving or sedative services. Even when they do, the coverage may differ from one plan to the next. There may also be copayments involved for such supplementary services.
Newborn care is covered by the mother’s medical insurance and deductible for the first 30 days of life. After this, add your baby to your policy so that they continue to enjoy coverage.
In And Out-Of-Network Coverage
Try to stay in-network for maternity care and childbirth if you’re on a health plan with a preferred provider network. Going to out-of-network providers for childbirth carries additional costs to cover the difference between the bill and what your insurance covers.
However, off-network providers must provide you with their network status and an estimate of the additional charges 72 hours before billing you for the balance.
HMO plans may be more problematic. Because of their exclusive provider networks, they’re often cheaper but don’t cover off-network providers’ services.
Does Insurance Cover A Home Birth?
Many expectant mothers give birth in a hospital or childbirth clinic. Still, home birthing with the assistance of a midwife or doula is also a popular choice.
Unfortunately, ACA coverage does not always extend to these services. If in doubt, check the details of your specific plan, or be prepared to cover these costs out-of-pocket.
What Coverage Can I Get If I Am Pregnant And Uninsured?
If you are pregnant and uninsured, you should get health coverage immediately if you are in a position to do so. But if you have missed the ACA Open Enrollment period, options are still available.
The federal programs Medicaid and CHIP (Children’s Health Insurance Program) offer low-cost or even free coverage to pregnant women who have no income or are from low-income households.
Does insurance cover childbirth and maternity services? Yes – most ACA-compliant health insurance plans are ideal for people adding to their families. But after the baby has arrived, you’ll also need comprehensive healthcare benefits for the entire family.
This is why choosing the right health insurance plan is so crucial. Enhance Health is here to help. We take the stress out of selecting the right health insurance plan and help you find the right one for your needs and budget.
Contact us today, to get started.