What Does My Insurance Cover For Pregnancy

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Health Insurance and Pregnancy: Whats Covered and Whats Not

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What Does Pregnancy Insurance Cover

Pregnancy insurance covers all essential health benefits related to prenatal care. This can include prenatal visits, prescription drugs, laboratory services, gestational diabetes, delivery costs, and other maternity care essentials. It also covers newborn care. When evaluating insurance options during open enrollment or reviewing your health plan, look at out-of-pocket expenses, copays, deductibles, and coinsurance related to maternity coverage.

Since maternity care is classified as one of the Affordable Care Act Essential Health Benefits, as long as you buy a plan that qualifies under the ACA, youll have pregnancy coverage. This includes Health Insurance Marketplace andMedicaid plans, which cover care even if your pregnancy begins before coverage starts.

That said,Louise Norris, a licensed health insurance agent out of Wellington, Colo., explains that the exact details of whats covered in each state can vary depending on the specifics of the benchmark. So, its important to understand the details of how your plan works. Additionally, employer-provided coverage, either through the mother or a partner, offers pregnancy coverage however, you may have a waiting period until your coverage begins.

Be Aware Of Your Plans Network Of Providers

And try to stay within it. Regardless of what type of plan you havesuch as a PPO or an HMOyou will always have the lowest costs when you get care in your plans network, says Jennifer Fitzgerald, CEO and cofounder of Policygenius, an insurance marketplace that allows you to compare and buy insurance online. Thats because your health insurance company has pre-negotiated preferred rates with network providers.

But its not as simple as choosing an in-network ob-gyn and hospital. You need to make sure that all the medical professionalsincluding the anesthesiologist and nursesfall under the network umbrella, as well as all the labs involved with your care. Even if your plan provides some out-of-network benefitsas some PPO plans doout-of-network care will always cost more than in-network care. The difference could mean tens of thousands of dollars of out-of-pocket expenses. So make sure the hospital has on-staff options in network. When people get to the hospital, they forget about all that stuff, so its important to do it in advance. Keep a list and give it to your spouse or a family member so they know what to do once you go into labor, Gundling says.

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Can Uninsured Women Enroll In Marketplace Coverage Upon Becoming Pregnant

Only if it is within the established open enrollment period or a woman qualifies for a special enrollment period , does not have a plan that meets MEC through Medicaid or an employer, and meets income and immigration criteria. Note that except in the states of New York and Vermont, pregnancy does not trigger an SEP.

Under the ACA, people who do not qualify for Medicaid coverage that meets MEC, and have incomes between 100% and 400% FPL, qualify for advance premium tax credits and cost-sharing reductions , which they can use to reduce the cost of health insurance purchased through a Marketplace. Those with pregnancy-related Medicaid in the three states that do not constitute MEC are eligible for Marketplace subsidies. Certain lawfully-present immigrants with incomes under 100% FPL subject to Medicaids five-year ban in their state are also eligible for APTCs. Undocumented immigrants are not eligible for APTCs, CSRs, or Marketplace insurance.

Can Uninsured Immigrant Women Receive Medicaid Or Chip Services

FAQ: What happens if my health insurance doesnt cover a surrogate ...

Maybe. Immigrants with qualified non-citizen status are eligible to enroll in Medicaid if they otherwise meet state Medicaid eligibility requirements, but are subject to a five-year waiting period from the time they receive their qualifying immigration status before becoming eligible. Some categories of qualified non-citizens are exempt from the five-year ban because they are considered lawfully residing immigrants. For lawfully residing immigrants, the five-year waiting period was waived in 2010, giving states the option to provide lawfully residing immigrant women with pregnancy-related Medicaid regardless of the length of time they have been in the U.S. Twenty-three states provide pregnancy-related Medicaid to lawfully residing immigrants without waiting periods. For undocumented and DACA-eligible immigrants, states may provide undocumented immigrant women with federally funded prenatal services through CHIP. Some states may also provide prenatal care entirely using state funds.

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What If You Need Help Paying For Health Insurance

In most states, many pregnant women can get Medicaid coverage. Medicaid is a government program that provides free or low-cost health insurance to people with low income. In some states, pregnant women who earn too much for Medicaid can get health coverage through the Childrens Health Insurance Program . CHIP is a government program that provides health insurance to some children and pregnant women in families that earn too much to get Medicaid but cant afford private insurance. You can apply for Medicaid and CHIP at any time.

Even if you cant get Medicaid, you may be able to get tax credits that help pay for insurance through your states Marketplace. You can get information about health plans and costs for pregnant women in your states Marketplace. Be sure to say youre pregnant on the Marketplace application so you get pregnancy information.

Last Reviewed: September 2020

What About A High

If you have special testing, procedures or hospital stays requiring tests and treatment, these may not be completely covered by your insurance. If you have a high-risk pregnancy or a special test or procedure, my advice is to contact your health insurance company before you have those things done. They can let you know a cost estimate for specific procedures. And that will give you a sense of how to budget for it.

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Will My Parents Insurance Cover My Pregnancy

Shivani Gite is a personal finance and insurance writer with a degree in journalism and mass communication. She is passionate about making insurance topics easy to understand for people and helping them make better financial decisions.

Nupur Gambhir is a content editor and licensed life, health, and disability insurance expert. She has extensive experience bringing brands to life and has built award-nominated campaigns for travel and tech. Her insurance expertise has been featured in Bloomberg News, Forbes Advisor, CNET, Fortune, Slate, Real Simple, Lifehacker, The Financial Gym, and the end-of-life planning service.

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At Insure.com, we are committed to providing honest and reliable information so that you can make the best financial decisions for you and your family. All of our content is written and reviewed by industry professionals and insurance experts. We maintain strict editorial independence from insurance companies to maintain our editorial integrity, so our recommendations are unbiased and are based on a comprehensive list of criteria.

If you are pregnant and covered under a parents health insurance plan, their insurance will cover your pregnancy and childbirth. However, it is always a good idea to check with the insurance company because there may be some limitations or exclusions.

Key Takeaways

Contact Your Hotel Resort Or Tour Provider


It is unlikely that your hotel or resort will have specific pregnancy restrictions. You may, however, wish to check any restrictions for tours that you are interested in. Activities such as horseback riding, skydiving, and water sports may not allow participation if you are pregnant. Some tours may require that you provide a doctors note to participate, so make sure that you check your tour operators website, or give them a call, before you book.

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Ask For Thorough Records Before You Leave The Hospital

Have your spouse or a family member write down detailed notes on the services and tests youve received at the hospital, as well as the professionals you worked with. Then, before you check out, request an itemized bill and a copy of your medical chart. Keep them handy in a file, so that you can refer to your documentation if you need to talk with your insurance provider about your bill.

Health Insurance Options For You

  • Medicaid: Free or very low cost insurance for New Yorkers with low income. Pregnant New Yorkers can qualify with higher income and regardless of immigration status.
  • Private/Qualified Health Plans: Insurance plans on the NY State of Health Marketplace and directly from insurance companies. If you are pregnant, you can enroll outside of the open enrollment period on the NY State of Health Marketplace.
  • Family Planning Extension Program: Program for people who have Medicaid while pregnant but who no longer qualify after their pregnancy.

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Prior To 2014 Most Individual Plans Excluded Maternity Coverage Today All New Policies Include Maternity Benefits

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  • Health insurance & health reform authority

Prior to 2014, women who purchased their own health insurance were often completely out of luck if they wanted to have coverage for maternity. In 2013, the National Womens Law Center reported that just 12% of individual market plans included maternity benefits. And that was despite the fact that nine states required maternity benefits to be included on all individual plans.

In the rest of the states, maternity coverage in the individual market was extremely rare, and if it did exist, it was generally in the form of an expensive rider that could be added to a plan, usually with a waiting period. Yet even on plans that excluded maternity coverage, women were charged premiums that were at least 30% higher than those charged to men for the same coverage.

Before the Affordable Care Act made coverage guaranteed issue, pregnancy itself was also considered a pre-existing condition that would prevent an expectant parent male or female from obtaining coverage in all but five states. And many individual health insurance carriers considered a previous cesarean section to be a reason to decline an application or charge a higher initial premium. .

Is A Woman Who Has Access To A Family Members Employer

Infertility and Fertility Insurance Coverage

Possibly. If the employer-sponsored insurance is unaffordable or not MEC, the woman is eligible for APTCs. Affordability is determined by the IRS standards for the percentage of income a person is expected to spend on insurance. This calculation applies to the cost of the employees insurance, not the cost of the family plan. That means that if the premiums for the employees insurance are affordable, no member of the family is eligible for an APTC. If the individuals premium is unaffordable, the family will be eligible for APTCs in an amount determined by their income and the premium cost.

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What Benefits Does Pregnancy Medicaid Provide

Similar to other health care assistance programs, Medicaid does not pay monetary benefits directly to covered participants. Certain health care providers and health care facilities have a contract with Medicaid to treat those who are covered by Medicaid insurance.

When receiving Medicaid benefits, you should be given a list of medical providers who accept Medicaid or given a website to look for a provider in your area. As long as you receive care from a Medicaid provider, your health care costs will be submitted through Medicaid and will be covered. Pregnant women are covered for all care related to the pregnancy, delivery and any complications that may occur during pregnancy and up to 60 days postpartum.

Additionally, pregnant women also may qualify for care that was received for their pregnancy before they applied and received Medicaid. Some states call this Presumptive Eligibility and it was put in place so that all women would start necessary prenatal care as early in pregnancy as possible.

Talk with your local office to find out if you qualify for presumptive eligibility.

Pregnant women are usually given priority in determining Medicaid eligibility. Most offices try to qualify a pregnant woman within about 2-4 weeks. If you need medical treatment before then, talk with your local office about a temporary card.

What Questions Should I Ask Before Choosing A Health Plan To Cover My Pregnancy

Ask how much your deductible will be. In general, your deductible goes down as your monthly premium payments go up. Also, take the time to understand other out-of-pocket costs that come with your plan, such as copays and coinsurance.

Ask which providers are in your planâs network. You’ll want to know which obstetricians, hospitals, and pediatricians participate in the plan. Your plan will likely only cover preventive services in full and at no cost to you if you receive your care from in-network providers.

Review the planâs full summary of benefits and look it over closely. Pay close attention to any specific services you want or need to make sure they are covered by your health plan.

Once your baby is born, you qualify for a special enrollment period through the Marketplace during which you can add your baby onto your policy.

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How Long Does Medicaid Or Chip Coverage For Pregnancy Last

Medicaid or CHIP coverage based on pregnancy lasts through the postpartum period, ending on the last day of the month in which the 60-day postpartum period ends, regardless of income changes during that time. Once the postpartum period ends, the state must evaluate the womans eligibility for any other Medicaid coverage categories.

7. Is abortion covered by Medicaid or CHIP?

The Hyde Amendment, an annual requirement added by Congress to a federal appropriations bill, prohibits using federal funds abortion coverage except when a pregnancy results from rape or incest, or when continuing the pregnancy endangers the womans life. However, states may use their own funds to cover abortions, and 17 states currently do.

What’s The Most I Could End Up Paying In A Worst Case Scenario

Health Insurance : How to Cover a Pregnancy With Health Insurance

Find out if you have an annual out-of-pocket maximum and how that works. This is defined as the highest amount your insurer will ask you to pay for medical costs for the year. Once you’ve paid this amount, your insurer generally covers 100 percent of other medical costs you have for the remainder of the year.

However, read the fine print to find out what’s included in this amount. It almost always includes your yearly deductible. But it doesn’t necessarily include premiums or out-of-network costs. And you will still be responsible for amounts that are considered more than “reasonable or customary” for any service.

And remember that your pregnancy may start in one year and end in another, but your plan will only count the costs you paid in each calendar year toward your annual maximum for that year.

On the other hand, your doctor’s office may bill for everything at once, including prenatal care and delivery. You’ll want to work this out with your healthcare provider’s office.

Thanks to the Affordable Care Act, qualified plans are no longer permitted to have limits on the total amount an insurance company will pay for your care each year. Grandfathered plans may still have limits.

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Consider Cancel For Any Reason Coverage

Given that pregnancy is frequently not a covered reason for trip cancellation or reimbursement under a traditional travel insurance plan, you may wish to consider adding a Cancel For Any Reason upgrade to your policy. A CFAR upgrade lets you cancel your trip for any reason at all, and can reimburse you for up to 75% for your non-refundable trip costs.

There are a few requirements that accompany this type of coverage. You must insure 100% of your pre-paid and non-refundable trip costs. You are usually required to cancel your trip at least 48 hours before your scheduled departure, so make sure you plan ahead whenever possible. Your insurance provider may also require you to purchase the upgrade within 14-21 days of making your initial trip payment.

How Can I Determine If I Qualify For Medicaid

Qualifying for Medicaid is not as black and white as qualifying for most other government programs. Most government programs have some basic requirements along with very clear income guidelines to help individuals know if they qualify.But Medicaid has many ways that someone can qualifyand even though income makes up part of the eligibility requirements, it is not solely based on that. Even people with the lowest incomes may not qualify for Medicaid if they do not fall into one of the Medicaid groups.

And people who make a middle-range income may qualify if they fit one of the qualifying groups and can fall back on options such as share of cost

If you are pregnant and uninsured, Contact your local Medicaid office to find out if Medicaid is the right option for you.

Compiled using information from the following sources:

1. US Government Information

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Will A Marketplace Health Plan Also Cover A Newborn

Yes. The ACAs EHB requirement mandates coverage of maternity and newborn care. Newborn care covers childbirth and immediate care for the baby after birth. The specifics of this coverage will vary by state and by each individual plan, but all women in Marketplace coverage must also enroll their baby in coverage soon after birth.

If the newborn is eligible for Marketplace coverage, then the parents can choose to add the baby to the familys existing Marketplace plan or choose a new Marketplace plan for the baby. If they opt for the latter, they can enroll the baby into a new Marketplace plan at any metal tier. However, when enrolling a newborn into Marketplace coverage, other members of the household are generally not permitted to change their existing Marketplace coverage.

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