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Is there maternity coverage under ObamaCare?

Here's what you need to know...
  • Maternity care is considered an essential health benefit.
  • This means that all qualified insurance plans must cover maternity care.
  • If you’re applying for an insurance policy while pregnant, you cannot be denied because of your pregnancy.
  • If you don’t have insurance and become pregnant, you may have to wait for an open enrollment period to obtain insurance on the Marketplace.
  • You can apply for a private insurance policy at any time.

Maternity care has the potential to detect and treat a number of conditions in both the mother and the baby. It can include prenatal care, services provided at the time of childbirth, and care after the baby is born. All qualified insurance plans under ObamaCare must include pregnancy, maternity, and newborn care. However, women who become pregnant while uninsured may have to wait for the open enrollment period to apply for a Marketplace insurance plan, or they can apply for private insurance independently. If you’re looking for maternity care, it’s wise to spend some time comparing your options before signing up for a plan.

Prenatal Care

Regular prenatal care is an important part of maternity care. Physicians generally recommend visiting the doctor according to the following schedule:

  • One time a month between weeks 4 and 28
  • Twice a month between weeks 28 and 36
  • One time a week between weeks 36 and 40

Women who are considered high-risk might be asked to visit the doctor more often so that their conditions can be more closely monitored. Women at high-risk include those who:

  • Are age 35 and above
  • Smoke, use drugs or frequently drink alcoholic beverages
  • Have a medical history of having high-risk pregnancies
  • Have an underlying condition like diabetes, high blood pressure, or epilepsy
  • Are carrying more than one baby
  • Develop complications during pregnancy, such as having too much or too little amniotic fluid and pregnancy-induced high blood pressure

Is Prenatal Care Covered?

Plans that you obtain through the Marketplace, as well as Medicaid insurance plans cover prenatal care. Most insurance plans outside of the Marketplace also cover prenatal care. Under ObamaCare, certain preventive services are required to be provided for women who are pregnant with no cost-sharing from the patient:

  • Folic acid supplements
  • Gestational diabetes screening
  • Hepatitis B screening
  • Rh incompatibility screening
  • Syphilis screening

Other types of screenings not mentioned above may incur charges. In general, your insurance provider will share these costs with you, and you may be responsible for a co-pay or for a certain dollar amount before you’ve reached your deductible. Since insurance plans can be complex, you should review what your plan, or the one that you’re thinking about purchasing, includes.

Care at the Time of Childbirth

Coverage may vary according to the particular insurance plan. Costs also vary and have been found to range from $1,200 to $12,000, depending on the hospital and circumstances around childbirth.

To find out how much of that cost you’ll be responsible for, you can review the details of your insurance plan.

If you’re about to enroll in a plan and are currently pregnant or plan on becoming pregnant, now would be a good time to sit down and compare different plans.

Antenatal Care

After birth, you’ll receive free breastfeeding support. This is required under ObamaCare, and it includes lactation support by a trained counselor and the costs for renting or purchasing breast pumps.

How to Enroll in an Insurance Plan

During the Open Enrollment Period, which is generally between November 1 and January 31, you can enroll in a plan on the Marketplace. The plans on the Marketplace do vary in terms of cost and coverage, so you should read the fine print of a few different contracts before choosing one.

Having a baby is considered a life change that allows you to enroll in a plan at any time during the year.

You’ll simply sign up for coverage and have it begin the first day of the next month. Take note, however, that becoming pregnant is not considered the type of life event that can allow you to enroll in a plan on the Marketplace. You would have to wait until the next open enrollment period to get coverage for yourself. If this describes your situation, you can always look for individual coverage on your own. You can compare plans to see which ones may have the most affordable premiums.

Medicaid

You may qualify for Medicaid if you meet your state’s income requirements. Many states use 138% of the federal poverty level as the threshold. You can apply for Medicaid at any time.

The Children’s Health Insurance Program (CHIP) is related to Medicaid and provides insurance for children. Both of these programs are offered at little or no cost to the patients.

An Exception to the Rule

Certain types of plans are considered grandfathered plans. If you have a grandfathered plan, you have already been notified as such. They include, but are not limited to:

  • Job-based plans that were in place before March 23, 2010 and haven’t been changed substantially since then
  • Individual plans that were in place before March 23, 2010

These grandfathered plans are not subject to the rules of ObamaCare, and they don’t have to cover preventive care for women who are pregnant. If you have a grandfathered plan, you may want to consider upgrading your plan to one with more comprehensive coverage. You can shop around for the best option that meets your needs.

Should you enroll in a short-term insurance plan if you become pregnant?

Probably not. Short-term insurance plans are not required to provide the minimum essential benefits (of which maternity care is included), and they can deny you for a pre-existing condition (which pregnancy may be considered).

In most cases, maternity care is covered under ObamaCare. If you currently have a qualified health plan from the Marketplace, the majority of your preventive services as a pregnant woman will be covered, and most private plans also offer substantial prenatal coverage. Your out-of-pocket costs for certain prenatal services, hospital stays during childbirth, and follow-up appointments after birth will vary according to your plan. You can compare the advantages of different plans before applying for coverage. Enter your zip code in our FREE tool below to compare health insurance rates now!

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