Regular health care is particularly important for women during pregnancy and immediately afterward for both the mothers and the babies. Because health costs in the U.S. are exceptionally high, expectant women must have access to quality health insurance.
This type of care has not always been easily available to women. However, in 2014, the Affordable Care Act (ACA) mandated that pregnancy care be included in all healthcare insurance plans. Since the passing of the ACA, all healthcare insurance plans must offer prenatal, labor, delivery, newborn care, and even breastfeeding help. This is true whether or not the mother accesses the insurance through the online marketplace where ACA plans can be purchased.
(Note, however, that some plans in effect as of March 23, 2010, were “grandfathered” into the new system when the ACA was adopted. Those plans are not required to offer pregnancy and related care. It is important to know if you have one of these. Check with your human resources department.)
Insurance plans used to be able to decline to pay maternity and pregnancy if the woman was pregnant at the time she obtained the insurance. That is no longer the case. Pregnancy is no longer considered a pre-existing condition for purposes of preventing a woman from getting health insurance or from charging her much higher rates because of her pregnancy. Your pregnancy won’t prevent you from getting health coverage. Since the adoption of the ACA, you can no longer be denied health coverage for having a pre-existing condition, including pregnancy.
What Does My Health Insurance Cover for Pregnancy?
Although health insurance plans vary widely, and each has different coverages for different things, all health insurance plans should provide insurance for women if they become pregnant while on that healthcare plan. You do need to check your policy, though, for specifics.
Your policy may say something specific about maternity coverage, or it may require you to meet your deductible before the plan pays for larger expenses. Deductibles can be quite high, especially for a whole family on an insurance plan. Although some births are straightforward, others involve complications for both mother and baby that can lead to extremely high hospital bills. For these reasons, quality health insurance is essential.
At a minimum, your healthcare insurance plan must provide:
- All prenatal care visits with no co-pay since it is medical care you get during pregnancy. No co-pay means you don’t have to pay your healthcare provider each time you go for a prenatal checkup. You can also see your prenatal care provider without a referral from a primary care provider (the doctor who gives you basic health care). So you don’t have to see your primary care provider first to get an OK to see a prenatal care provider, like an obstetrician/gynecologist (also called OB/GYN), nurse-midwife, or nurse practitioner.
- Labor and birth services
- Breastfeeding helps with no co-pay. This includes visits with a lactation consultant, breastfeeding equipment, and breast pumps. A lactation consultant is someone with special training in helping women breastfeed.
- Birth control
Health care law says that a plan can’t:
- Drop your health insurance if you get pregnant
- Charge you more for health care services because you’re a woman
- Charge you more for health care services if you were pregnant when you started the insurance
- Set a lifetime or annual cap (limit) on coverage. This means that an insurance company can’t stop covering your medical expenses once they reach a certain amount of money.
- Make you pay unlimited costs out-of-pocket. Insurance plans have to set yearly limits on what you pay on your own for health care. Once you reach the limit, the company has to pay your expenses through the rest of the year.
Knowing the details of your insurance coverage before heading to the hospital to give birth can save you from a very unpleasant surprise when it is time to take your newborn home and pay your hospital bills.
What Happens If I Lose or Quit My Job While I’m Pregnant?
Whether you are fired or you voluntarily leave your job, your insurance through your employer will be discontinued, either immediately or within a short period. You should check to see if your employer provides COBRA coverage. The Consolidated Omnibus Budget Reconciliation Act (“COBRA”) is a federal program that makes sure employees who are covered under The Employment Retirement Income Security Act (“ERISA”) are not deprived of group health coverage after their original coverage is terminated.
COBRA laws provide that some former employees can continue their benefits for a prescribed amount after they stop working. Unfortunately, the cost of insurance under COBRA is high and can be prohibitively expensive.
If you cannot use COBRA, or it is not offered, and you cannot use a spouse’s health insurance, you will want to consider shopping for a new plan. Some rules prohibit people from beginning new insurance on the ACA’s Healthcare Marketplace except during the “open enrollment” period (usually starting in early November and lasting about six weeks.
There are exceptions, though, and one of these exceptions is for people who have lost their jobs or health insurance. They may apply for ACA plans outside of the open enrollment period. Having a baby (although not pregnancy itself – this refers to the delivery of a child) is also an exception that allows you to apply for plans outside the open enrollment period.
Depending on your income, you may qualify for Medicaid insurance, and your child may qualify for the Children’s Health Insurance Program (CHIP). You can enroll in these at any point during the year. Medicaid is a government program that provides free or low-cost health insurance to people with low income.
In some states, pregnant women who earn too much for Medicaid can get health coverage through CHIP. CHIP is a government program that provides health insurance to some children and pregnant women in families who earn too much to get Medicaid but can’t afford private insurance.
What If My Employer Changes My Insurance Plan?
This is less of an issue now that the ACA has been passed since the ACA mandates that all health insurance plans (apart from grandfathered plans) must provide prenatal, labor, and birth insurance coverage. While your employer’s healthcare insurance plan must cover these occurrences, they do not need to provide any specific level of care.
They may change it if they choose to do so. If you have insurance through your employer, you will want to check your coverage immediately after starting your job and stay informed of what is covered if it changes. Check into what costs are covered and what your plan’s deductible is. If it is quite high, you may pay your prenatal and birth expenses alone.
When My Baby is Born, Will My Baby Get Health Insurance?
The ACA also mandates newborn coverage. Your new baby should be covered under your existing health insurance. Adding the baby is not automatic, and after you give birth, it is very important to contact your insurance company immediately to ensure that they are added to your health insurance plan.
Do I Need a Lawyer If I Have Concerns About My Health Insurance While Pregnant?
Although you may not need an attorney to seek health coverage, an experienced insurance lawyer can help you get the necessary health insurance coverage, if needed, and can also help you seek reimbursement for your costs. They can assist you if you have been denied coverage or experienced illegal action.
