Whether you are planning children into your future, amid a pregnancy, or have just given birth, having a health coverage plan is essential for managing the planned and unplanned healthcare costs for you and your baby. Maternity and infant care can be expensive, but health coverage enables you to engage in prenatal and postnatal care, minimizing the mother, your chances of complications during pregnancy.
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Best Health Insurance Options for Pregnant Women
The best health insurance options for pregnant women are those that will supply adequate coverage for outpatient prenatal care, inpatient care, newborn care, and lactation assistance. Shopping for an individual plan on your state’s marketplace can help determine your eligibility in federal health insurance programs or assist you in finding another suitable option.
If you do not yet have insurance and are looking for an individual marketplace plan, understand that you may need to wait until open enrollment, which typically begins November 15th of each year. You may be eligible to apply at any point if you qualify for a Special Enrollment Period, such as moving or losing coverage. Being pregnant does not make you eligible for special enrollment, but the birth of a child does. If you qualify for either Medicaid or CHIP in your state, you can enroll at any time.
While marketplace plans typically provide robust and comprehensive health coverage, these plans are typically more expensive than federal programs or employer-sponsored insurance. Marketplace plans cover all essential health benefits, including maternity services. Metal-tier plans on the marketplace determine the freedom to choose your healthcare provider and your cost-sharing rates. For pregnant women, gold plans tend to provide the most care without the hefty price tag of a platinum plan. Gold plans are best for individuals requiring routine and specialized care, perfect for a new mom.
If these marketplace plans are not an affordable option, read on to learn more about the nuances of employer-sponsored insurance, federal programs, and supplemental coverage options.
Employer-Sponsored Health Insurance
Employer-sponsored health insurance can provide coverage through either the pregnant mother or through a spouse from a group insurance plan. Employers with over 50 full-time employees are required under the employer mandate to provide health insurance to their full-time or full-time equivalent employees. These plans are beneficial if the employer pays for a portion of your health insurance premiums to help reduce your payments. Some employers, health care plans may have a waiting period before you can reap the benefits to prevent adverse selection - when sick individuals apply for health insurance only after they have become ill.
If you use your parent’s employer-sponsored health insurance for your care, assuming you are under 26 years of age and have become pregnant or have a child on your plan under 26 years old that becomes pregnant, health insurance can get a bit more complicated. Adult children classified as dependents under an employer health care plan are not eligible to receive coverage for pregnancies of their children. In this case, the best health insurance option would be to look into Medicaid or marketplace health insurance.
If you are pregnant and enrolled through an employer’s health insurance plan, but then you switch jobs or leave entirely, 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 severe if you are further along and require more care. To stay covered, your employer typically provides you with information for enrolling in a COBRA plan upon termination of your employment. COBRA allows you to receive all of the same pregnancy benefits and necessary coverage on medical expenses as your previous health insurance, but it is more costly.
It is important to note that while your employer may provide you with health coverage, you will want to understand your company’s family leave policy, as they are often separate policies. You may need to carefully plan your prenatal and postnatal care around your allowed time off unless utilizing disability leave or additional disability insurance.
Medicaid or CHIP
A pregnant woman can enroll in Medicaid and CHIP's federal programs that provide free or low-cost health coverage to millions of Americans. Specifically, these programs assist low-income families and children and pregnant women and newborns in affording healthcare. Eligibility for these programs depends on household size, income, citizenship, or immigration status. The states both administer Medicaid and CHIP, so specific rules and benefits may vary, depending on your location.
According to the National Health Law Program (NHeLP), a pregnant woman is eligible for full-scope Medicaid coverage at any point during pregnancy if eligible under her state’s requirements.
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If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage, and they’ll remain eligible for at least a year. If found eligible during your pregnancy, you’ll be covered for 60 days after you give birth. After 60 days, you may no longer qualify. Your state Medicaid or CHIP agency will notify you if your coverage is ending, at which point, you can enroll in a Marketplace plan to avoid a break in coverage.
If your household income exceeds the income limits for full-scope Medicaid coverage, you may still be eligible for pregnancy-related Medicaid. A woman is entitled to Medicaid under the coverage category for “pregnancy-related services” and “conditions that might complicate the pregnancy.” The income limits for pregnancy-related Medicaid vary by state. Still, states cannot drop eligibility for this coverage below an income of 133% to 185% of FPL (Federal Poverty Level), according to NHeLP. Conditions as a mother you can expand their own Medicaid income eligibility at their discretion.
Children’s Health Insurance Program (CHIP)
You can apply for Medicaid or CHIP anytime during the year, not just during the annual Open Enrollment period. You can use two ways, directly through your state agency or by filling out a Marketplace application and selecting that you want help paying for coverage. If found eligible during your pregnancy, you’ll be covered for 60 days after you give birth. After 60 days, you alone may no longer qualify, but your child may. According to the Department of Health and Human Services (HHS), CHIP benefits vary by state; they each provide comprehensive coverage, such as:
- Routine check-ups
- Doctor Visits
- Dental and Vision Care
- Inpatient and Outpatient Hospital Care
- Laboratory and X-ray Services
- Emergency Services
The cost of CHIP also varies by state, but you would not have to pay more than 5 percent of your family’s annual income. Your state Medicaid or CHIP agency will notify you if your coverage is ending, but you can enroll in a Marketplace plan during this time to avoid a break in the coverage.
If you are not eligible for benefits through federal programs or cannot enroll in a plan, or have a high-risk pregnancy, you want to consider supplemental insurance. Supplemental maternity insurance makes cash payments directly to you instead of directly to your healthcare providers. These plans do not cover pre-existing conditions and must be purchased before conception. Disability insurance and hospital indemnity insurance provide supplemental coverage, while Medicare has strict eligibility criteria and only covers maternity services under specific Medicare packages.
While Medicare is typically associated with coverage for individuals over 65, you may be eligible for Medicare due to disability. For pregnancy or childbirth, you would be covered for hospital services under Medicare Part A. Medicare Part B would protect the doctor services and outpatient procedures, including lab tests and blood work. After the birth of your child, Medicare would not cover services for your baby at all.
Short-Term Disability Insurance
Disability insurance may replace the mother’s income during maternity leave or be directed by her doctor to be on bed rest. Each employer has its own family leave policy, and not every employer pays your full salary while on leave upon extension of your leave. The Federal Family Leave Act (FMLA) only guarantees 12 weeks of unpaid leave under specific doctor directs her eligibility criteria.
When you get hired, or should you forget your company’s leave policy, you should clarify these details with your employer. If they do not offer your full-salary pay during their allowed weeks of leave, you may want to consider a short-term disability plan or hospital indemnity insurance. Considering pregnancy is regarded as a pre-existing condition, you would have to be enrolled in these plans before conception. So in a perfect world, these would be a great option, as these plans do not cover pre-existing conditions and are intended to be supplemental means for insurance.
Hospital indemnity insurance is helpful for labor and delivery, but prenatal services are limited. These types of plans cover all of your expenses for hospital admission and delivery of your child. If your child is born prematurely or needs to be admitted to the neonatal intensive care unit (NICU) or ICU, these plans are designed to help cover more extended hospital stays. If you anticipate a high-risk pregnancy or delivery, these low-cost supplemental plans could be something to consider.
Checking your local resources could also find you some leads on affordable healthcare. Specific organizations, such as community health centers, Planned Parenthood, or specific payment programs may exist upon eligibility. Talk with your local Planned Parenthood or even religious organization to see if they have assistance programs.
Health Insurance for Maternal and Infant Care
It’s no secret that the high costs of care associated with pregnancy can hinder the excitement of expanding your family, but knowing your health coverage options and expected costs can help reduce this burden. The challenging part is that most hospitals do not offer transparency when estimating childbearing and postnatal care costs. Prices depend on the state you live in, your health insurance enrollment, and usually the type of birth plan, whether that be vaginal birth or cesarean delivery.
You may also have unanticipated complications during delivery or during pregnancy, such as gestational diabetes or placental issues, which can also increase your costs. These challenges are not always in your control, but having the ability to engage in prenatal care can help reduce the likelihood of these complications and the associated costs.
According to a 2015 study, of the nearly 137,000 infants studied, over 75 percent were born to mothers who had experienced at least one complication during pregnancy. Costs of these complications ranged in severity and price between $987 to $10,287. This indicates that complications are common during pregnancy, and delivery may increase healthcare costs for newborns immediately following birth.
Health Insurance Coverage for Pregnant Women
According to the Kaiser Family Foundation, most employer-sponsored plans, ACA-compliant individual plans, marketplace plans cover maternity services such as childbirth and newborn care. These plans also cover prenatal visits and screenings, folic acid supplements, tobacco cessation intervention, and breastfeeding services. These services are covered without cost-sharing because they are considered preventative care. For more information on the routine tests commonly conducted during pregnancy, the American College of Obstetricians and Gynecologists (ACOG) listed them out for you here.
Best Health Insurance for Pregnant Women Frequently Asked Questions (FAQs)
For more information on budgeting while pregnant, check out these additional questions.
How do the costs for vaginal delivery differ from a C-section?
We spoke with Payton Leonard, Health Insurance Expert for Life Insurance Post. She states C-sections cost nearly $10,000 more than a natural vaginal delivery if the mother is uninsured. With insurance, C-sections cost a little over $4,000 more than standard delivery. While you may want the more affordable option, consult with your doctor on their recommendations for the best outcome for you and your baby.
Do insurance premiums increase during or after having a baby?
When planning to acquire insurance during pregnancy, the rates will depend on your age and current condition. If you are at risk of some severe pregnancy conditions, it is most likely that your premiums will be higher. If you have the history and assess that you are at risk of those, then these will be covered by your insurance provider, says Nick Schrader from Texas General Insurance. These things will affect the cost of your insurance premiums which makes you pay higher amounts, but an insurance company is not allowed, by law, to raise insurance premiums based on pregnancy.
How much should a mother budget in the first year of care for her baby, in addition to insurance costs? (Diapers, sanitation, lactation, formula, etc.)
According to Leonard, the range differs for each family depending on household income. Still, generally, a mother should parcel out at least $12,500 for the year for all the necessities along with health insurance.
Nick Schrader from Texas General Insurance suggests utilizing vaccinations that the government covers for making care more affordable. Also, cloth diapers may be a more sustainable and economical way compared to disposable diapers. And, of course, breastfeeding may save you tons of money in comparison to formula. Talk with your doctor about what is suitable for you and your baby.
One more tip from Schrader, “pregnancy is already complicated. Don't make it harder stressing yourself on how you will pay the expenses it causes. Be wise and get yourself comprehensive insurance coverage so you can focus more on your delivery and taking care of your newborn.”
For additional information regarding maternity care:
Having some form of health coverage is especially important while pregnant, not only for a new mom but also for the developing baby. Having health coverage has been linked to reducing the risk of complications during labor and delivery, reducing the costs associated with family planning.
Mira provides low-cost lab screenings beneficial to new and expectant mothers. Signing up takes seconds, and the interface is incredibly user-friendly, without any hassle or time-wasters. Your time and energy may be limited as a mother, but our empathetic and caring customer service team is happy to help you find affordable care in your area! Try Mira today.