Pregnancy has many highs and lows and many, many doctor’s appointments. Your prenatal care will consist of various doctor’s appointments, several blood tests and screenings, a few ultrasounds and multiple vaccines. Even though prenatal care is guaranteed under the affordable care act, not all plans are created equally. If is very important that you have good pregnancy insurance to ensure you receive quality care at a reasonable price.
Do I Need Health Insurance?
Pregnancy is a time that requires a tremendous amount of medical care. On average, without insurance, prenatal 
care costs approximately $2000. Labor and delivery without complications costs over $10,000. However, in the United States, 1 in 3 women deliver via c-section. Additionally, at least 60% of women have an epidural. “Complications” can push costs upwards of $30,000! You can absolutely find less expensive options, but should the unexpected arise, you will definitely want health insurance. Also, under the ACA women are guaranteed breastfeeding support in the form of breast pumps and lactation counseling.
Benefits Covered by Pregnancy Insurance
Prenatal care (pregnancy insurance) is one of the essential services under the Affordable Care Act. Under the ACA, all routine prenatal care must be covered without additional expense. Routine care includes prenatal visits, prescription folic acid supplements, and screenings for gestational diabetes, anemia and more. Additionally, women are guaranteed breastfeeding support in the form of a breast pump and lactation counseling. Although routine care is guaranteed, the ACA’s language regarding specific benefits can be a little unclear and some carriers offer more extensive benefits than others. For example, not all carriers will automatically cover vaccines recommended during pregnancy or things deemed outside the definition of “routine care”. For this reason, we’d recommend contacting a broker to ensure you get the best possible prenatal care.
Types of Pregnancy Insurance Plans and Services
If you receive insurance through your employer, you are most likely guaranteed prenatal and newborn care unless your plan was somehow grandfathered in before the Affordable Care Act. Check with your HR department for those details. Also, if you were insured through your employer, but you or your spouse were recently laid off, you may be eligible for COBRA.
If you don’t have health insurance and you are pregnant, you may qualify for Medicaid. There are certain financial criteria that you must meet based on the Federal Poverty Level and your state. Generally speaking your income needs to be below 100%-200% of the FPL. In some states, you may even qualify for the CHIP program if you are pregnant. Check out Medicaid.gov or contact your Medicaid office to see if you qualify. If you’d like to learn more about Medicaid, you can check out our article all about medicaid or watch our helpful youtube video.
You can also enroll in a plan through the Marketplace. However, you will most likely have to enroll during the open enrollment period. This is every year from November 1-December 15. Coverage begins January 1st. In most states becoming pregnant does not qualify you for a special enrollment period, however in some states it does. Check out healthcare.gov for more information.
Remember, currently, under the ACA you cannot be denied coverage based on your pregnancy status. In previous years, pregnancy was considered a pre-existing condition and you could therefore be denied, charged more, or forced to go through a waiting period. Currently, the only type of plans that do not have to cover you for pregnancy are short term medical plans.
I STILL can’t get health insurance
If you don’t have health insurance, can’t get COBRA, are ineligible for Medicaid and are nowhere near the open enrollment period for the Marketplace, there are still options for healthcare. First and foremost, call a broker! Even though pregnancy may not qualify you for a special enrollment period, there may be other qualifying life events that do!
You may also want to consider paying in cash for a midwife/nurse practitioner. You can receive the same quality of care as an OB/GYN at a much lower price. Of course, this is an entirely personal decision. Additionally, you can look to planned parenthood or other free clinics for low cost or free prenatal care. Whatever you do, do NOT wait to book your appointment while you sort out your health insurance. Many OB/GYN’s will not take on new patients past 20 weeks and you do not want to be without a doctor that you trust.
Reviving quality care throughout your pregnancy is of utmost importance, so please if you have any questions feel free to call us at 888-918-0518 or schedule an appointment today. There is absolutely no charge for our services. We work for you, not the insurance company. Also remember, even if your options are currently limited, the actual birth of a child is a qualifying life event that will make you eligible for a special enrollment period in the marketplace. So, once your baby arrives, you may have more options.
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
