Health Insurance Options for Maternity and Pregnancy Expenses

June 20, 2018

Pregnancy insurance is essential if you plan to have a baby. Without insurance, you can expect to pay between $10,000 and $12,000 in fees related to giving birth. With the right coverage, you can reduce those fees and enjoy the months following the birth of your baby rather than dealing with the stress of extensive medical bills.

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Job-Provided Insurance and Pregnancy Coverage

If you have insurance through your employer, your insurance must cover pregnancy-related expenses. The exact coverage will depend on the chosen plan. You should discuss the various options with your HR department and/or insurance company. You may find plans that cover as little as 25% of the maternity expenses and those that cover as much as 90% of expenses.

Private Health Insurance and Pregnancy Coverage

If you don’t have coverage through your employer and you have private health insurance, you may or may not have pregnancy coverage. The following gives you an idea of what you might expect:

  • Marketplace Insurance – If you bought an insurance policy through the Marketplace, it must cover pregnancy and maternity expenses. This means even if you were pregnant before you bought the insurance, you are still covered as pregnancy is one of the 10 essential health benefits.
  • Insurance outside of the Marketplace – If you already had private health insurance, your policy isn’t required to offer pregnancy coverage. If you had the coverage in place as of March 23, 2010, it is a grandfathered plan. This means the insurance company does not have to provide you with coverage for childbirth and other related expenses.

Medicaid or CHIP

If you don’t have employer-provided insurance or cannot afford insurance through the Marketplace, you may be eligible for Medicaid or CHIP.

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Your state runs your Medicaid or CHIP programs, but they all provide the same basic benefits. You must make less than the stated income for your state in order to qualify. They also base it on your family size and need. Medicaid is available to more individuals and families than ever before. You do not have to wait for a specific open enrolment period – you can apply for your state’s insurance at any point.

The Covered Services

If you have coverage for pregnancy and childbirth, you will likely have many of the following benefits:

  • Coverage for outpatient services that include doctor appointments, tests, and medications
  • Coverage for inpatient services before and during childbirth that require a stay in the hospital
  • Coverage for the care of your newborn baby
  • Coverage for lactation assistance after the birth of your baby

Watch for Open Enrollment

Unless you are applying for state aid, you can only obtain new insurance through the Marketplace or your employer during the open enrolment period. The only exception to the rule is if you have a life-changing event. Becoming pregnant is not a life-changing event, though. Once you have the baby, that is a life-changing event, but that could leave you without coverage for the pregnancy itself.

If you don’t have insurance, make sure you apply during the open enrollment period. Open enrolment for the Marketplace usually occurs in the fall. If you are applying for insurance through your employer, talk with them to see when their open enrollment period occurs.

Having coverage for pregnancy and childbirth isn’t as hard as it used to be because it’s an essential coverage now. That doesn’t mean you should take for granted that you have coverage. Talk with your insurance provider to see what type of coverage you have so that you know what to expect when the bills start rolling in after the birth of your baby.

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