Pregnancy insurance is a great way to minimize the cost of prenatal care and hospital stays when you give birth. All Marketplace and Medicaid plans cover pregnancy and childbirth. This applies even if your pregnancy begins before your coverage starts.
Antenatal care and newborn care (services provided before and after your child is born) are important health benefits. This means all eligible health plans inside and outside of the Marketplace must cover it.
The 2 common ways to get health insurance while you’re pregnant are through your employer or from the Affordable Care Act health insurance marketplace at HealthCare.gov, sometimes called Obamacare. There may be other options if you are pregnant and unable to afford health insurance through one of these sources.
- Medicaid/CHIP
Many low-income pregnant women qualify for Medicaid or CHIP, which is funded by states and the federal government. All state Medicaid programs can provide coverage during pregnancy with no cost sharing. You can take a brief quiz on HealthCare.gov to see if you qualify for Medicaid in your state.
Medicaid does not have an open enrollment period, so you can get Medicaid or CHIP at any time of the year if you’re eligible.
If you register in health insurance while you’re already pregnant, Medicaid retroactively covers qualifying medical bills. Medicaid pays for pregnancy-related medical expenses incurred within three months before enrolling in a plan. But you must be eligible for Medicaid during that time to have services covered. - Non-Health Insurance Options
You might also consider pregnancy care via local organizations. For example, Planned Parenthood and public health centers such as the Hill-Burton Program provide free or discounted medical care to eligible pregnant women.
Community health centers, which frequently offer services in at-risk areas, are also an option for pregnant women who don’t have health insurance.
You can buy health insurance at any time during pregnancy as long as you are eligible to buy coverage at that time. Women cannot be denied health insurance or charged more for coverage as a result of pregnancy.
You usually can only purchase health insurance coverage during open enrollment periods. For Affordable Care Act (ACA) plans, open enrollment occurs every year from November 1 to January 15 in most states. Employers establish their own open enrollment periods.
Pregnancy doesn’t automatically start a special enrollment period in most states, so make sure you’ve purchased health insurance before getting pregnant. You may be entitled to a special enrollment period after your child is born, but by then it will be too late to cover the cost of the birth.
There are 3 ways for pregnant women to get health insurance during the open registration period:
- Enroll in an ACA plan via the health insurance marketplace.
- Get a health plan through your employer.
- Buy individual health insurance directly from a health insurance company.
There is a way to get health insurance without an open enrollment period, but many Americans don’t qualify. Medicaid and the Children’s Health Insurance Program (CHIP) allow you to enroll for coverage at any time if you are eligible. You qualify based on your household income, and that varies from state to state.
How to Get Health Insurance During Pregnancy
Pregnancy and childbirth can be very expensive, so having health insurance is essential. Here’s a suggestion to keep in mind when comparing options.
- Find out your health insurance eligibility.
This includes choices from your company and your partner. See if you can join a company group health insurance plan, which is often more affordable than the ACA marketplace. - Take a look at the ACA markets.
The ACA marketplace offers plans in 4 ACA tiers: Bronze, Silver, Gold, and Platinum health plans. Gold and Platinum plans have the most expensive premiums but the lowest out-of-pocket expenses. This may be a better plan if you are pregnant or planning to do so for the next year. Bronze and Silver plans have lower premiums but can be expensive when you need healthcare, making it potentially more expensive for pregnant women in the long run. The benefit of the ACA marketplace is that health plans are eligible for advanced premium tax credits, which are based on your household income and family size. - Make sure your provider takes health plans. Whatever health plan you choose, review the provider network to make sure your OB-GYN and other providers are in that plan’s provider network. Check to see if your chosen hospital or birth center is also an in-network facility. The best way to check whether a provider is in-network is to call the doctor’s office or facility and make sure the specific plan is considered in-network. Do not rely on an insurance company’s provider list on its website. The list may be incorrect or contain outdated information.
What is the Cost of Health Insurance for Pregnant Women?
Health insurance costs for pregnant women depend on a variety of factors including age, plan type, provider, deductible, coinsurance percentage, and more. If we look at unsubsidized silver HMO plans for pregnant women between the ages of 25 and 40, the premiums range from $270 to $375 per month (for women in the Los Angeles area). Bronze plans offer lower premiums and higher out-of-pocket costs, while gold and platinum plans offer higher premiums and lower out-of-pocket expenses.
