Find Cheap Health Insurance Quotes in Your Area
Maternity coverage has greatly improved in recent years, as the Affordable Care Act (ACA) requires health care plans to cover pregnancy services. The best health insurance will provide coverage for all pregnancy costs, including prenatal testing, blood work, ultrasounds, monthly or weekly doctor visits and the labor and delivery of the baby. These medical bills can add up quickly, with the average cost of pregnancy ranging from $9,000 to $200,000 without insurance. More affordable plans are also available, such as hospital indemnity policies, but they don't include as many benefits as other maternity coverage.
Is pregnancy a preexisting condition?
Pregnancy is considered a preexisting condition, but recent laws mandated that all marketplace, employer-provided and Medicaid plans must cover maternity and newborn care. Before this legislation, you could be denied coverage due to your pregnancy. Today, pregnancy is considered an essential health benefit that health insurance companies must cover. Some typical pregnancy expenses include:
- Weekly doctor visits
- Ultrasounds and sonograms
- Lab work
- Obstetrician and gynecologist (OB-GYN) visits
- Birthing classes
Many of the medical bills for pregnancy can be very costly if you do not have health insurance, which makes finding an affordable policy crucial.
Considerations for maternity health insurance
The best health insurance for you will depend on whether you're currently pregnant or plan to conceive in the future. In many situations, you will be able to get the best health insurance possible if you plan ahead, as you will have more options for maternity coverage. For example, if you currently do not have health insurance from an employer, you should plan to purchase a policy during the open enrollment period, which typically occurs from the start of November to the end of December.
Even when pregnancy comes as a surprise, there are still great health insurance options if you do not have coverage when you become pregnant. These can include options like Medicaid or off-exchange health insurance policies, which both can be purchased at any point during the year.
Does insurance cover surrogate pregnancy?
If you currently are using a surrogate for pregnancy, then there are health insurance implications that you should be aware of. Intended parents are always required to provide health insurance for a surrogate. Furthermore, the surrogate's health insurance will not provide pregnancy coverage. Therefore, you would need to use your own health insurance to cover the maternity and newborn expenses during the pregnancy of the surrogate.
There are no limitations or differences in what health insurance policies cover for surrogates. All of the policies highlighted below would offer the same coverage whether you were carrying a child or a surrogate carries the child for you.
Does Medicare cover pregnancy?
If you are currently enrolled in Medicare due to a disability or your age, you would be covered for pregnancy or childbirth. Under Medicare Part A, all hospital services would be provided, while Part B of the policy would cover the doctor services and outpatient procedures, including lab tests and blood work. However, after the birth of your child, Medicare would not cover services for your baby at all.
Changing insurance or jobs during pregnancy
If you are pregnant and enrolled through an employer's health insurance plan but then you switch jobs, you may have to wait before joining the new health insurance plan. This may not be an issue if you are early in your pregnancy, but it could be more serious if you are further along. To bridge this gap, you can enroll in your former employer's COBRA plan, in which you would receive all of the same pregnancy benefits from your previous health insurance. COBRA insurance is costly, but it would provide the necessary coverage for your medical bills.
We would not recommend changing insurance plans while pregnant, as your coverage options may be limited. Typically, it is harder to find a full pregnancy benefit policy while you are pregnant when compared to planning ahead and purchasing a plan before conception. That's because pregnancy is classified as a preexisting condition.
Will short-term health insurance cover pregnancy?
Since pregnancy is considered a preexisting condition, short-term health insurance plans do not typically provide maternity coverage. If you currently have a short-term plan and are considering having a child, we would recommend buying a private health insurance policy that would provide coverage for all pregnancy expenses.
Best health insurance for pregnancy
The best health insurance for pregnancy will be determined by your income and whether your (or your spouse's) employer provides health insurance. There are three types of health insurance plans that provide the best affordable options for pregnancy: employer-provided coverage, ACA plans and Medicaid.
Employer-sponsored health care
The simplest health insurance option for pregnant women is employer-provided coverage, either through the mother or her spouse. This can be especially useful if your employer pays for a portion of your health insurance premiums, which reduces your payments. It is important to note that some employer health care plans will have a waiting period, typically three months from the date your coverage begins, during which benefits would not be provided. This is to prevent sick individuals from applying for health insurance only after they have become ill.
Under the Health Insurance Portability and Accountability Act (HIPAA), the birth of a child qualifies you for a special enrollment period in which you can enroll in a plan, but becoming pregnant does not.
Adult children who are classified as dependents under an employer health care plan are not eligible to receive coverage for pregnancies or their children. This may become an issue because you are allowed to stay on a parent's plan until the age of 26. In this case, the best health insurance option could be to look into Medicaid or marketplace health insurance.
Marketplace health insurance
Marketplace health insurance provides maternity care and must cover all of the essential health benefits listed under the ACA. Furthermore, the insurer can't deny coverage for a preexisting condition, and you won't need to undergo a waiting period.
Typically, a marketplace policy can only be purchased during the open enrollment period for your state, which requires you to plan ahead. ACA plans can also be purchased if you experience a qualifying life event, which then activates a special enrollment period. This can include events such as getting married or losing your job. However, becoming pregnant is not a qualifying life event and thus would not open a special enrollment period. On the other hand, giving birth is a qualifying life event.
Missed open enrollment?
If you still need health insurance and missed open enrollment, you can enroll in an off-exchange plan that provides the same coverage. However, these policies can be more expensive if you rely on premium tax credits or cost-sharing benefits, which can only be applied for through on-exchange health insurance policies.
Marketplace plans with a higher monthly premium and lower deductible provide the most coinsurance and can help you save on out-of-pocket costs. Check out your state's Silver-, Gold- or Platinum-tier health plans and figure out what works best for your situation.
Medicaid and CHIP
Depending on your income level, you could be eligible for coverage through Medicaid. Since Medicaid is regulated by the ACA and federal government, it must provide the same maternity, prenatal and newborn insurance coverage as marketplace and employer policies. Additionally, Medicaid does not have designated waiting or enrollment periods, which means you can apply for coverage at any point during the year.
The Medicaid program allows low-income individuals to enroll in a plan and receive health care benefits if their household income falls below certain limits. Most states have passed the expanded version of Medicaid, which allows anyone with a household income of less than 138% of the federal poverty level to be eligible. However, you should check to see if your state has adopted the Medicaid expansion.
The Children's Health Insurance Program (CHIP) is a separate health insurance program that provides coverage for children under 19 years old and pregnant women. The policy is similar to Medicaid, as it is a low-income insurance plan designed for families and individuals.
CHIP health coverage can provide a critical safeguard for women who earn too much for Medicaid coverage and cannot afford an ACA plan. The following states provide full pregnancy benefits without premiums and coinsurance under CHIP:
- District of Columbia
- New Jersey
- Rhode Island
Other states that have adopted this legislation may require a pregnant woman to pay part of the premium and use coinsurance for pregnancy coverage. For this reason, you should check your state's CHIP-provided services before relying on this plan for pregnancy health insurance.
What is supplemental insurance for pregnancy?
Supplemental maternity insurance coverage is a health insurance policy that makes cash payments directly to you rather than paying the gynecologist, hospital or other health care providers. There are two main forms of additional insurance that you can purchase for pregnancy: short-term disability and hospital indemnity. However, both of these policies must be purchased before conception, as they do not include coverage for preexisting conditions.
Disability insurance for pregnancy
A short-term disability or maternity leave insurance plan is designed to replace the mother's income during maternity leave and if her doctor orders bed rest. Some employers will pay the full salary amount when a woman goes on maternity leave, but not every company does. For this reason, you should consult your employer to find out its maternity leave policy. If it does not support maternity leave or only provides a few weeks' worth of pay, then purchasing a short-term disability plan might be the best option.
Another pregnancy policy that may be useful for your situation is a hospital indemnity plan. This is not a complete coverage policy like other health insurance plans. Instead, it is considered a substitute health care plan if you cannot afford a typical health insurance policy.
The hospital indemnity plan covers all expenses for admission to the hospital and the delivery of your child but does not provide prenatal coverage or therapy. Additionally, the indemnity plan can provide extra benefits if your infant is born prematurely and needs to be admitted to the neonatal intensive care unit (NICU).