Which Health Insurance Is Best For Pregnancy

Aetna Maternity Insurance: Best For Customer Service

Maternity Coverage in Pregnancy Health Insurance | Best Insurance Plan for Pregnancy
Company Overview
  • About 1.2 million health care professionals
  • More than 700,000 primary care doctors and specialists
  • More than 5,700 hospitals nationwide

Founded in 1853, Aetna is one of the nations leading diversified health care insurance providers. It offers insurance products in all 50 states and provides individual and family medical plans. Aetna doesnt currently offer individual plans. In some states, health insurance plans may contain limitations and exclusions. Explore state-specific information before choosing Aetna as your health insurance provider.

Family Planning Only Coverage

You’re eligible to receive 10 months of Family Planning Only coverage after your pregnancy coverage ends, regardless of how it ends . This includes all forms of birth control, permanent methods to stop having children, and health checkups related to receiving birth control. This coverage is automatic.

What If My Baby Is Unwell Or Premature

Specialist nursery care is available in private hospitals for any baby who is unwell or any baby born between 32 and 37 weeks of pregnancy. Your baby will be charged separately for their nursery care, in addition to the charges for your hospital stay. Check with your health fund to see if your baby is covered.

Babies who are very premature , and those who are very unwell, are transferred to a Neonatal Intensive Care Unit in large public hospitals and the costs are covered by Medicare. If you go into labour before 32 weeks, you will usually be transferred to give birth in a large public hospital where your baby can receive specialist care as soon as it is born.

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Medicaid For Pregnant Women & Chip Perinatal

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SNAP, TANF and Lone Star Card Information

Pregnant women without health insurance might be able to get free health coverage during their pregnancy through Medicaid for Pregnant Women or the CHIP Perinatal program.

Medicaid provides health coverage to low-income pregnant women during pregnancy and up to two months after the birth of the baby.

CHIP Perinatal provides similar coverage for women who can’t get Medicaid and don’t have health insurance.

To get Medicaid for Pregnant Women or CHIP Perinatal, you must be a Texas resident and a U.S. citizen or qualified non-citizen.

When you apply, we’ll ask about your family’s monthly income to see if you can get Medicaid or CHIP Perinatal.

What Pregnancy Benefits Should You Consider When Looking At Plans

Health Insurance Benefits For Pregnant Women

Ifyou are pregnant or plan to become pregnant, some important things to considerabout your current or any potential health insurance plan are:

  • Ifyou need a referral to see a specialist/OBGYN from your primary care physician
  • Thecovered cost of labor and delivery
  • Yourcopay, coinsurance, and deductible amounts
  • Ifprenatal testing is covered ultrasounds, amniocentesis, and genetic testing
  • Ifyou need to be preauthorized to receive prenatal care
  • Ifnon-traditional deliveries covered midwives and home-births .
  • Ifprivate rooms are covered or if you will need to share a room during hospitaldelivery.

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How Do I Know What Specific Benefits Are Covered

Healthplans are required to provide a Summary of Benefits and Coverage documents. Thesummary will detail how each specific plan covers the cost of pregnancy andchildbirth. If you are pregnant or plan on getting pregnant, review thisSummary to see how your plan or to compare how different plans cover childbirth,this way you will know what to expect and are less likely to get any surprisemedical bills.

Keepin mind that these services are covered by major medical plans even if you gotpregnant before your coverage starts. Thanks to the ACA, pre-existingconditions are covered, this includes pregnancy.

Itsalso important to consider that if you have a grandfathered individual healthplan this is not the kind of plan you get through your employer, its a planyou buy yourself arent required to cover pregnancy and childbirth. If you havea grandfathered individual health insurance plan, you may want to call yourinsurance company to learn about your plans pregnancy and childbirth coverage.

Is Pregnancy A Pre

No, pregnancy isnt considered a pre-existing condition for insurance. It was once considered a pre-existing condition, but the ACA changed that.

Dodge says health insurance companies arent allowed to charge more for health insurance or deny coverage if youre pregnant. This also goes for a pregnancy pre-existing condition, like gestational diabetes or preeclampsia.

In addition, newborn babies who are enrolled in health insurance within 30 days cant be denied coverage. The same rule applies to newly adopted children and children who are up for adoption.

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How To Get Pregnancy Insurance

You can only apply for a new pregnancy insurance policy during the open enrollment period unless you experience a qualifying life event, in which case you can enroll through a special enrollment period.

Before you buy pregnancy insurance, you need to decide what type of plan you want and how to purchase it. This really comes down to what kinds of insurance you can qualify for, which one is the most budget-friendly, and which one has the best coverage.

If youre a full-time employee with access to health benefits, talk to your employer and see what coverage their plan offers for pregnancy. You can also compare plans through the ACA marketplace.

Once you find a health insurance plan that meets your needs, the enrollment process is usually pretty simple. Youll select your health plan, add dependents if you have any, and choose the date you want your coverage to start.

If you enroll in your employers group health insurance plan, the premiums are typically deducted from your paycheck. If you enroll in coverage through the ACA marketplace or buy an individual plan through a private provider, you usually receive a monthly billing statement for the amount you owe.

Cover For Midwives And Doulas

Health Insurance While Pregnant

A private midwife can provide pregnancy care, sometimes under an agreement with an obstetrician and in some states may be able to attend births in hospitals, birth centres and at home.

A doula is an extra support person who does not provide medical services but can provide extra support. They can help you and your partner to prepare for the birth process and offer relaxation techniques such as massage to help you during labour. They also usually visit you after the birth and can help with a debrief and referral to other services, for example if you have problems with breastfeeding.

Both models of care are associated with a lower rate of interventions.


  • Care by a midwife could cost between $3000 and $6000.
  • Depending on the whether the midwife is endorsed by the Nursing and Midwifery Board, under some circumstances Medicare and some private health funds may pay part of the cost. It’s important to check with the midwife beforehand.


  • Depending on experience and level of service provided, costs usually range from $800 to $2000.
  • Doulas do not qualify for Medicare or health fund rebates.

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How To Get Health Insurance From An Obamacare Plan

The best thing about buying a health insurance plan through your state’s Obamacare marketplace: everybody can do it. Assuming the timing is right, of course. In other words, assuming you do it during the yearly open enrollment period. Or you qualify for a special enrollment period.

If the planets align in that way, though, you may be in luck. Many marketplace plans provide a lot of maternity and childbirth coverage for a reasonable price. That can especially be the case if you choose a plan in the right “metal” category. For example, if you go with a “silver” plan and you qualify for discounts in the form of cost-saving reductions, you could save hundreds or even thousands of dollars each year.

One bonus of at least checking out the online Obamacare marketplace if youre pregnant or youre planning to become pregnant: when you apply for a plan there, it’ll let you know if you’re eligible for the discounts discussed above. It’ll also tell you if you’re eligible for Medicaid or CHIP coverage.

As mentioned earlier, becoming pregnant doesn’t qualify you for a special enrollment period, so plan ahead for that, if possible. Actually having your baby does qualify you for it, however. Even better, when you enroll in a marketplace plan in advance of your delivery, you can make sure the coverage is effective the day your newborn enters the world.

How To Get Health Insurance Coverage Through A Spouse

Getting health insurance through a spouse is another great option if you’re pregnant, or you’re planning to become pregnant, and they have an employer-sponsored plan that’ll cover you.

The questions you should answer before getting health coverage through a spouse, though, include:

  • How much will you have to pay per month to be added to your spouse’s plan?
  • Will it provide all the coverage you’ll need during your pregnancy?
  • What about copays and co-insurance? How much could they cost you throughout your pregnancy?
  • How will this plan cover your newborn? And how much might that cost you and your spouse?

If you’re happy with the answers you receive to those questions, go ahead and join your spouse’s health insurance plan. If you’re not happy with those answers, though, weigh your options. A plan bought through your state’s ACA or Obamacare marketplace may be a better bet. Or you might find that buying a plan directly from an insurance company provides the best coverage for the best price.

And, again, don’t forget about Medicaid. Should you qualify for it, it could provide you with the best coverage for the best price of all the options discussed here.

To learn more about this topic, check out our article about picking the right plan when both spouses have employer-sponsored health insurance.

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What Are My Out

Some costs are not covered by private hospital health insurance. These include:

  • specialist consultations and check-ups with your obstetrician
  • a portion of the hospital fees
  • paediatrician visits

However, some of these costs can be claimed on Medicare. For more information, check with your insurer and ask your hospital or visit the following websites:

Covered Services For Expecting Mothers And Babies

Does health insurance cover maternity expenses

Maternity services covered by health plans include:

  • Outpatient services, such as prenatal and postnatal doctor visits, gestational diabetes screenings, lab studies, medications, etc.
  • Inpatient services, such as hospitalization, physician fees, etc.
  • Newborn baby care
  • Lactation counseling and breast pump rental

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Key Points To Understand In Your Policy

If you have insurance through your employer, youll probably be given plenty of paperwork concerning insurance coverage. While thats a good place to start, its also important to explore beyond that and go directly to your insurance carrier. Health-care companies have a customer service area and they put a lot of enhancements in their website, so using an app or going online can get you a lot of that information, says Richard Gundling, Healthcare Financial Management Associations senior vice president of financial practices. Take notes on the following:

Be Aware Of Elective Services

Though they may not seem elective to you, everything from certain pain medication to your newborns circumcision could be considered elective services by your health-care provider. Read your policys fine print and then make the decision if these costs are worth covering on your own. If you need an emergency c-section, ask if that is covered, since some insurance plans consider that an elective and will not cover it, Katz says. However, if you do need a procedure, an appointment with a specialist or something else that isnt covered, there are steps you can take to ease the financial burden. In some states, a mother may be able to apply for financial assistance or even Medicaid in these situations, says Daggett. Its best to reach out to your clinic. Most clinics have patient advocates who help patients find ways to handle the financial issues that might arise.

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How To Get Health Insurance Through A Parent

Are you under the age of 26? If you don’t currently have health insurance, but you have a parent who does, see if you can be added to their plan.

If your parents health insurance plan covers dependents, it should cover you and you should be able to stay on it until you turn 26.

This is true of job-based health plans as well as those bought from a state marketplace or from an insurer directly.

As is pretty much always the case with these kinds of things, you’ll likely have to wait for the next open enrollment period to come around before you can join a parent’s health plan. That is, unless you qualify for a special enrollment period. For this to happen, you must go through a “life event” like losing health coverage, moving, or getting married.

Curiously, adopting a child and even having a baby makes you eligible for a special enrollment period, but becoming pregnant does not.

Other than that, all of the advice shared regarding the coverage options explained above is applicable here, too. Basically, thoroughly review and check out this kind of coverage before you sign on the dotted line.

Should you decide to get health insurance coverage through a parent, know that you’ll have to find your own coverage once you turn 26. You won’t have to do this the day that happens, thankfully your parent’s plan should cover you until Dec. 31 of that same year.

Get An Estimate On How Much The Birth Of Your Baby Will Cost

Pregnancy Insurance 2021 – What You Need To Know

One easy way to understand the cost of having a baby under a health insurance plan is to review the planâs Summary of Benefits & Coverage document. The SBC is required for each plan under Obamacare. Request this document from the insurer . Toward the back of the document, the costs of having a baby with the plan will be spelled out as a coverage example .

Those costs can be out of control without an adequate in-network policy. Plus, emergency procedures need to be taken into account. One in 10 babies deliver preterm, according to the Centers for Disease Control and Prevention. Neonatal intensive care for newborns can produce “astronomical” costs without the right in-network plan in place, Haney says.

Maternity coverage should be comprehensive across the entire pregnancy â not just when baby is born. Ask questions of your current insurer about their maternity coverage. When selecting a plan, make sure youâre comfortable with the planâs network of providers and consider the following when planning out your healthcare budget.

  • Prenatal services, health screenings, lab work, ultrasounds and birthing classes across all three trimesters

  • Medical conditions that could complicate the pregnancy

  • High-risk pregnancy factors, like unplanned obstetrical surgery, epidurals, premature births, incubation or extended stays in the neonatal unit, NICU or maternity ward

  • Also find out if elective procedures like the following are included in the insurance plan:

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    Know What Services Are Covered Under Your Insurance Plan

    Under the Affordable Care Act, all major medical health insurance plans are required to cover pregnancy and maternity care, Fitzgerald says. Besides delivery and inpatient hospital services, your insurance typically should cover:

    Prenatal services, health screenings, lab work, ultrasounds and birthing classes across all three trimesters.

    Treatment for medical conditions that could complicate the pregnancy .

    Procedures or treatments resulting from pregnancy complications, unplanned obstetrical surgery, epidurals, premature births, incubation or extended stays in the neonatal unit, NICU or maternity ward.

    Pediatric and/or routine and emergency care after baby is born, plus necessary immunizations, vaccinations and checkups in the early months and years of babys life.

    Pregnancy: What Are You Covered For When You Deliver

    If you have chosen the hospital where you would like to have your baby, then it may be a good idea to contact that hospital or the healthcare provider you have selected, to find out whether they charge above the Medicare Benefit Schedule listed fee. You may face greater if your obstetrician charges above the MBS fee and doesnt have a no gap agreement with your health insurer.

    Its important to also find out exactly what you can claim for and what youll end up being billed for by checking with both the hospital and your health insurer. It is a good idea to review and update your single or family health insurance policy to select the options you are looking for and determine how much the premium and excess will be.

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    Understand Who Is Considered A Provider And In What Settings

    Not all providers are considered equal in the eyes of health insurance. Consider what type of care youre looking for, says Jessica Daggett, a doula and childbirth educator who has worked in insurance for eight years. Are you hoping to see an ob-gyn or a midwife? Do you want to give birth in a hospital setting, freestanding birth center or at home? From there, youll need to find out what is covered for your choice of birth setting. Not all insurance plans will cover out-of-hospital births.

    Does Health Insurance Cover Prenatal Care And Other Pregnancy Services

    Maternity Coverage When Pregnant Without Health Insurance

    Yes. Routine prenatal, childbirth, and newborn care services are essential benefits. And all qualified health insurance plans must cover them, even if you were pregnant before your health coverage started. Talk with your doctor or contact your health insurance company for more information about the services your plan covers.

    If you dont have health insurance and youre pregnant, plan to get pregnant, or you just gave birth, you may be able to get coverage for yourself and your baby through Medicaid or the Health Insurance Marketplace. Read more on healthcare.gov.

    Your state may also have programs that provide free or low-cost medical care and as well as additional services to help you have a healthy pregnancy. For more information, call 1-800-311-BABY .

    Some Planned Parenthood health centers may offer free or low-cost pregnancy services, or offer resources for affordable care where you live. Contact your local Planned Parenthood for more information.

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