Best Health Insurance Options for Pregnant Women

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Maternity coverage has greatly improved in recent years, as the Affordable Care Act 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 pre-existing condition?

Pregnancy is considered a pre-existing 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 all health insurance companies must cover. Some pregnancy expenses typically include:

  • Obstetrician and gynecologist (OBGYN) visits
  • Birthing classes
  • Delivery

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. For most 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 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 as your previous health insurance. COBRA insurance is costly, but it would provide the necessary coverage for all 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 pre-existing condition.

Will short-term health insurance cover pregnancy?

Since pregnancy is considered a pre-existing 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, Affordable Care Act (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.

Adult children who are classified as dependents under an employer health care plan are not eligible to receive coverage for pregnancies or their child. 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 would 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 pre-existing condition, so you won't need to undergo a waiting period.

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. Once you give birth, your newborn will be eligible for coverage from your health insurance provider. Additionally, under the Health Insurance Portability and Accountability Act (HIPAA), the birth of your child will open a special enrollment period in which you can purchase newborn insurance. This is a 30-day period which allows you to enroll your new baby in your family's plan on the state marketplace.

Missed open enrollment?

If you still need health insurance and missed open enrollment, you can enroll in an off-exchange plan, which provide 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

If you do not receive coverage from an employer, cannot afford to purchase a marketplace policy or miss open enrollment, you can still get 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 the 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 addressed this legislation.

The Child Health Insurance Program (CHIP) is a separate health insurance policy that provides coverage for children under 19 years old and pregnant woman. The policy is similar to Medicaid as it is a low-income insurance plan designed for families and individuals, but the household income threshold is slightly higher—coverage includes anyone with income below 185% of the federal poverty line.

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 the CHIP program:

  • California
  • Colorado
  • District of Columbia
  • Illinois
  • Minnesota
  • New Jersey
  • Rhode Island
  • Washington
  • Wisconsin

Other states that have adopted this legislation may require a pregnant woman to pay some 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 pre-existing 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 she is ordered for bed rest by her doctor. Some employers will pay full salary 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 full salary, then purchasing a short-term disability plan would be the best option.

Hospital indemnity

Another pregnancy policy that may be useful for your situation would be a hospital indemnity plan. This insurance is not a complete coverage policy like other health insurance plans. Instead, it is considered as 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 would 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).

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