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The In’s and Out’s of Pregnancy Insurance?


If you’ve ever had to pay for having a baby without the help of your health insurance, it must have been prior to 2014 and the Affordable Care Act. Before that, pregnancy insurance wasn’t considered an essential coverage, but a pre-existing condition. Only about 12 percent of plans in the individual market included pregnancy coverage.

With the advent of the ACA, maternity coverage is one of ten essential health benefits that all insurance plans are required to include. The exceptions are individual (as opposed to employer-provided) health plans bought prior to 2010 that were grandfathered in. Grandfathered plans are not required to provide coverage for pregnancy or childbirth.

What’s Covered in Pregnancy Insurance?

Maternity services covered by insurance include:

  • Inpatient care – This includes services provided when you’re checked into a hospital, such as nursing care, physician fees, radiology, bloodwork and more.
  • Outpatient care – If you receive services but are not admitted to the hospital, coverage includes pre- and post-natal doctor visits.
  • Newborn care – Well-baby checkups, preventive services,
  • Mom and baby home visits – If you qualify, home visits services are offered during pregnancy and up to three years after the baby is born.
  • Lactation – You can receive counseling from a lactation specialist and rent a breast pump.
  • Screening tests – Preventive care includes tests for gestational diabetes, anemia, hepatitis B and Rh incompatibility.
  • Counseling – New mothers can receive services and information about post-partum depression, smoking cessation, preventing violence and more.

When Can You Enroll in or Change to Another a Health Plan?

As you may know, you can change ACA plan coverage during the Open Enrollment Period and,if you qualify, a Special Enrollment Period (SEP). All ACA and Medicaid plans cover pregnancy and birth. Once your baby is born, if you want to enroll or switch to a new plan you can; your coverage will begin retroactively from the day your baby is born.

Do You Need Pregnancy Insurance?

To get coverage for pregnancy, birth and aftercare you’ll need to shop around for the plan that fits you and your family’s needs. A good way to get started is to get quotes from a variety of companies online. You just key in your zip code, follow instructions to provide relevant information and soon you will receive your quotes online.

Learn about your state’s insurance guidelines using this interactive tool.

Insurance Reference Guides

Where you live may affect your coverage options. Our reference guide will assist you in findoing plans available in your state.

Insurance Terms Glossary

From "absolute liability" to "written premiums," we've done the work for you to define commonly used insurance terms.

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