Maternity health insurance and childbirth benefits are widely available. We help you find the most affordable medical coverage in your area for prenatal, labor, postnatal, and delivery expenses. We also understand the costs and concern when you become pregnant, and we make the insurance part easy and as low-cost as possible by taking advantage of our free quotes online. You’re just a click away from viewing the lowest prices from major companies for both pregnant and expectant mothers.
As one of the 10 required “Essential Health Benefits,” coverage is included for all persons, including expectant mothers, on all Marketplace plans. Individual and small employer plans are required to provide maternity, postnatal, prenatal, and newborn medical care. Additional supplementary benefits are also often included. All Medicaid and Marketplace plans provide benefits for childbirth and pregnancy.
Applicants that are currently enrolled in an Exchange plan that will be kept, should not report a pregnancy. If a pregnancy is reported, it is possible that Medicaid or CHIP eligibility will be available. If eligibility is approved, the state agency will issue benefits and a Marketplace plan will no longer be available. When eligible for CHIP, Medicaid, or an SEP, coverage can begin at any time throughout the year.
Generally, you can purchase a policy with no waiting period if it is during an Open Enrollment period. Throughout the year, special enrollment situations allow you to secure coverage regardless if Open Enrollment has already ended or not yet begun. You also may be eligible for immediate 2023 coverage through an employer, or easily apply for healthcare benefits for an unborn baby. State-based programs, including Medicaid and CHIP may also be available, if you meet family income level requirements.
Enrollment applications are accepted throughout the year with no fees and free assistance available. Out-of-pocket expenses can vary, depending on the carrier and tier of plan. Supplementary plans are also offered to help pay uncovered expenses. First-dollar and accidental plans have become increasingly popular when coupled with an Exchange plan.
It All Changed Nine Years Ago
Beginning nine years ago, these types of benefits became mandatory on all plans through the Marketplace. Considered a required “Essential Benefit,” the law (Affordable Care Act) requires that during Open Enrollment (or SEP periods) pregnancy and delivery expenses are included without any waiting periods or special deductibles. No surcharges apply, and there is no maximum benefit limit if complications occur. Although network providers should be used to lower out-of-pocket expenses, emergency situations can be treated at any facility. Extended hospital stays, if medically-necessary, are covered, including complications to mother and newborn.
Complications and cesarean sections are also covered, along with required extended stays in a hospital. It’s important to have coverage since the expense of having and delivering a baby can cost about $25,000 – $30,000 for a normal vaginal birth, and $40,000-$50,000 for a C-Section. Although a qualified policy won’t cover 100% of the expenses, the amount you owe can be low, depending upon your policy. Your newborn can also obtain guaranteed coverage. Zero deductible plans are offered with varying out-of-pocket expenses. Higher deductible plans are sometimes more cost-effective.
Another big change is the availability of federal subsidies that instantly reduce the premium you pay for coverage. Although you must qualify (based on your household income), most Americans that apply for coverage receive some type of financial assistance. Often, the money received pays most of the premium. For applicants (and their family) over age 50, the savings can be more than $10,000 per year. Often, monthly rates are less than $50, and if cost-sharing is available (Silver-tier plans only), deductibles and copays can substantially reduce. However, if the projected household income increases throughout the year, a subsidy adjustment should be made.
Free health insurance for children may also be available in your area. The combination of Medicaid expansion, CHIP eligibility and large federal subsidies to bigger families has significantly reduced the cost of young person coverage. And regardless of the type of plan you choose, preventive benefits will be offered with no applicable copays or coinsurance. And no waiting periods either! Many immunizations and tests are also fully covered, including pandemic-related (COVID) expenses..
Important Note: After Open Enrollment ends, if you are uncovered, although the birth of a child counts as a qualifying life event, and thus, an exception, the new policy can be written on the newborn, but not the Mother (or Father). So although medical expenses will be covered (office visits, hospital expenses, etc…) for the child, cost of delivery and prenatal expenses must be paid out-of-pocket. An uncovered parent can apply for private coverage through several carriers, including Group options provided by an employer.
Preconception Evaluation: Genetic counseling, social support, childbearing counseling, and nutrition, exercise, vitamins, and alcohol/tobacco support.
Prenatal Care: Fetal evaluation, weight gain, nutrition, breast-feeding, HIV infections, selection of the best providers, and professional education.
Ancillary Services: Ultrasound, diagnostic testing and x-rays, newborn and dental services, and genetic screening and counseling.
Contraceptive Methods: Education and counseling of patients, barrier (sponge and diaphragms), Hormonal (vagina rings and birth control), implanted devices (IUDS), and sterilization procedures.
Breastfeeding benefits are also provided (support, equipment, and counseling).
Typical maternity benefits also include OBGYN visits, prescriptions, diagnostic tests, hospital expenses and coverage for complications including C-Sections. Additionally, there may be other required visits to physicians and specialists. You will be able to apply online if you purchase a policy so that your coverage can begin as quickly as possible. Since the average cost of all expenses, including delivery, is about $12,000, it’s important to secure benefits during Open Enrollment or other designated parts of the year. The effective date of benefits may begin on the first of the month, so coverage should be secured the previous month.
Comparing affordable maternity insurance benefits will allow you to choose among different plans. We feel this is important since there are large differences between policies offered by the major carriers. By researching as many as 12 different companies instead of a few, we find the specific benefits that best match your needs, while keeping the premium low. Whether you prefer a large hospital with a separate birthing facility, or a smaller regional facility, treatment should be available. If you are traveling or suddenly treated at an out-of-area facility, coverage is available.
You Can Get Health Insurance If You Are Pregnant
As an essential health benefit, maternity is always covered, regardless of age. Pregnancy is not considered a pre-existing condition, but is covered on all Exchange plans. At the time you attempt to enroll for coverage on a Marketplace plan, an applicant can not be denied because they are pregnant, or suspect they are pregnant. A higher rate also can not be charged by an insurer of pregnancy or any other physical, mental, or emotional condition.
Prenatal and related coverage begins on the effective date of the policy. Although you are asked if you are pregnant on the standard Marketplace application, benefits are still offered. Note: If a pregnancy and delivery occur with different Marketplace carriers and different calendar years, two deductibles will have to be met.
Waiting Period Required In Previous Years
Perhaps the most important aspect is the waiting period. Naturally, if you feel you need benefits to go into effect within a few months, a long waiting period will not help. Fortunately, with the passage of Obamacare, waiting periods were eliminated and maternity benefits, as previously mentioned, became an “essential” (required) coverage. Open Enrollment plans have a January 1 effective date, regardless if prior coverage was active. February 1 effective dates are also offered for applicants that apply after December 15th.
If you are uninsured, but enroll in a plan during Open Enrollment, delivery, surgery, in-hospital, and other expenses will not be covered until January 1. Thus, an uninsured applicant that needs coverage October 1, will have a “waiting period” of three months. If the policy lapses throughout the year, without a qualified event, benefits will not be covered until the following January 1.
Previously, for PPO plans, the waiting period was longer than other options. Although there were differences between carriers, often there was a 270-day window that benefits were not be paid. Of course, not all policies required a waiting period, but there was often a reduction in benefits. Pre-existing conditions from prior deliveries were also not covered.
During the nine months, you were still paying premiums, but were not able to use any of the provisions of the policy. This limitation was placed in the policy by the insurer to protect against too many claims being paid in a short period of time. Once the waiting period had expired, the insured was covered for the standard and typical expenses that might arise. However, policies could be terminated, based upon projected future medical expenses paid by the insurer.
However, a deductible and coinsurance did still apply. Contraception/birth control were not covered, except on many employer-sponsored policies. Now, these expenses are covered on Marketplace policies. Since waiting periods have been eliminated, it’s possible that you can secure complete coverage within 15-20 days. Short-term plans, however, do not cover these types of benefits. Newborns also don’t have many temporary plan options, although addition to qualified plans is typically allowed.
HMO Plans May Be The Best Option
Picking the right plan is always difficult. Although not all areas have available HMO plans, if they are offered, it can potentially reduce your out-of-pocket bills by thousands of dollars. HMO maternity benefits, like other options (PPO, EPO, POS, etc…) no longer have a separate deductible to meet. So instead of the $2,500, $5,000, or higher amounts that existed many years ago, there are not two policy deductibles. The normal policy out-of-pocket expense limits apply.
Thus, the bulk of your out-of-pocket cost for a one-night stay in the hospital might be approximately $2,000-$4,000. Of course, there could be other items that might have copays to pay. And there’s always the possibility that your stay in the hospital will be longer due to complications.
But you’ll find that most Health Maintenance Organization (HMO) (and PPO) policies provide a wide range of choices to match your situation. The maximum allowed out-of-pocket expense (per person) is $9,100 and $18,200 (per family). Larger families (regardless of the number of children) also have the same maximum expense limit. Note: Non-ACA plans often have no maximum expense cap.
Often, depending on the company, there are many other benefits provided by the health insurer with their maternity coverage. For example, nutrition counseling is routinely covered on may plans. This is especially important if you are pregnant. Some of the other specific topics that may be offered include what foods to avoid, information on prenatal vitamins, weight-gain discussions, special discounts offered by local businesses and what exercises are best during this time. Personal trainers and coaches are often provided.
But the benefits do not end after the delivery. If there are complications (such as a C-Section), benefits are provided, including the extra time in the hospital. Often, temporary depression issues may arise. And sometimes postpartum depression (PPD) may last much longer. These issues are also included in Marketplace medical plans. Generally, there are provisions for physical therapy to be covered, although there may be a small copay required. Mental health visits and counseling are covered for both inpatient and outpatient treatment.
However, before treatment, verification of coverage is always a good idea. There may be limits or exclusions that you should be aware of regarding the number of times you can utilize a specific feature of the policy. HMOs, for example can greatly vary, depending on which part of the country you live. Many companies treat eating disorders differently, depending on what part of the pregnancy it occurred. Infertility treatment is not currently included on most plans although it could change in the future. This type of treatment is often costly with large out-of-pocket expenses.
The Affordable Care Act
Beginning nine years ago, newborns and children (and adults too!) could not be denied coverage because of medical conditions on private or job-sponsored policies. Many essential benefits related to prenatal and delivery began to be offered on each plan. Baby and well-child visits also are now included for the newborn. Stand-alone dependent policies are offered if both parents do not need coverage, although a federal subsidy may not be offered. Rates can vary depending on the state and available carriers.
For most applicants, maternity benefits can be easily purchased from several carriers. Please feel free to take advantage of our free online quotes. We match the best available plan with your current needs, and determine how much your federal subsidy will lower the rate. If a subsidy (instant tax credit) is not available, the cost of coverage will remain fairly low since the age of the applicant is very young. Rates are often nearly-identical for applicants between the ages of 1 and 18.
Medical Expenses Covered During Pregnancy
Qualified Exchange (Marketplace) plans cover pregnancy, delivery, and childcare expenses. Effective dates of new plans (from most recent Open Enrollment) begin January 1. However, expenses beginning on that date are covered even if the covered female was pregnant before the policy went into effect. Although pregnancy is considered a pre-existing condition, you will not be denied or charged a higher premium when you enroll in a Marketplace (on or off-Exchange) plan.
The newborn can also obtain guaranteed benefits (with pre-existing conditions covered) outside of an Open Enrollment period. Since an SEP (Special Enrollment Period) will be created, all offered plans in the county of residence will be available with no exclusions or separate waiting periods. Before enrolling, it’s prudent to verify that your pediatrician is a network-approved provider. Otherwise, a new physician may have to be selected.
What Health Insurance Company Is Best For Maternity Coverage?
Since qualified Marketplace benefits are mandated and nearly identical for all carriers, one specific company is not likely to have the best option in all states. Deductibles, copays, and maximum out-of-pocket expenses will vary in different areas. The cost of delivery and in-hospital treatment will also differ from one state to another.
Companies that have strong local networks often feature popular maternity packages offered by area hospitals. Several of these carriers include Gunderson Health Plan, Medica, CHRISTUS Health Plan, Florida Health Care, Aspirus Arise, Dean, Sanford Health Plan, Piedmont Community Healthcare, Absolute Total Care, HMO Louisiana, QualChoice, and Avera Health.
Employer Obligations Under Current Healthcare Laws
The size of the employer (how many employees) typically helps determine the federal and state statues that apply. The Pregnancy Discrimination Act (a US Federal Statute) states that workers can not be singled out or discriminated for childbirth, pregnancy or medical conditions. Also, women that are impacted by these three conditions can not be treated differently than other employees with similar job performance. The Act amended Title XII of The Civil Rights Act of 1964.
The law applies to past, present and future pregnancy and also provides protection from harassment. Typically, any expenses (blood tests, x-rays, etc…) must also be treated similarly to other ailments and without an extra copay, deductible or exclusion. NOTE: This is a major change from policies issued pre-2014.
Pregnancy, childbirth and maternity expenses are covered once again on Marketplace plans. If the birth occurs after the Open Enrollment period ends, benefits are effective the day the baby was born by using an SEP (Special Enrollment Period) provision. Up to two months is given to officially select and enroll in a plan.
If you have existing coverage that is Exchange-compliant, you do not have to change to a different policy. You can retain your existing plan, or apply for a new policy. However, if your income has substantially changed, a new subsidy determination should be calculated.
Marketplace Open Enrollment for coverage begins on November 1st. New rates will be released within the next 30 days, and prices are increasing in almost every state. Increasing maternity and pregnancy costs, which are 1 of the 10 required essential health benefits, are helping fuel the higher prices.
However, a change in out-of-pocket maximums may save many households thousands of dollars. The maximum amount will be $9,100, regardless if the maximum family amount is as much as $18,200. Thus, the individual maximum cost-sharing limit will apply, and not the family amount. This is very relevant to households that deliver a child, but have very few additional medical expenses.