Getting Maternity Care Covered
There are some key things to know about having the prenatal and delivery care you need covered by insurance. Most health insurance companies consider pregnancy a pre-existing condition, and are therefore hesitant to cover services. It is important to find a health plan that accommodates pregnancy even if you’re uninsured when you get pregnant. While you can’t buy coverage specifically for maternity needs, it is included by certain private health plans and by all plans on the health insurance exchange. As an essential health benefit (EHB) according to the health reform law, maternity and newborn care is covered without a waiting period on exchange plans.
Maternity and Individual Health Insurance
East Coast Health Insurance sells plans from multiple national companies and about 30-40 regional carriers that cover maternity services. We can also enroll you in a plan on your state’s exchange, which covers maternity and newborn care without a waiting period by default.
If you are looking for maternity coverage, please call 888 803 5917 and be sure to mention you are trying to get your pregnancy, labor and delivery, and hospital stay covered. Plans like United Health One and Kaiser Permanente provide maternity coverage as an additional benefit or included in several of their comprehensive plans. Some regional carriers also cover maternity, such as Medica in the Midwest. Due to the health care law, no insurer can impose a waiting period for maternity coverage, or decline you for being pregnant when you apply. This gives you instant access to prenatal preventive care at no cost, and coverage for OB-GYN office visits, as well.
Under Obamacare, insurers in each state must include at least ten essential health benefit categories in each of their comprehensive plans, but not all states may choose to cover the maternity and newborn care category. If you live in one of these states, you can purchase a comprehensive plan on or off the exchange and expect to have coverage throughout your child-birthing journey. In other states, you can apply for a plan through the health insurance marketplace for guaranteed access to maternity and newborn care.
If your health insurance plan offers coverage for maternity services, many types of care will be covered. You may have to pay a copay or coinsurance at an office visit, but the plan will pay some portion of the costs. The plan you choose determines how much you pay for care throughout pregnancy and childbirth, whether you pay a deductible, coinsurance or a fixed rate. Some maternity services are free, as they are preventative and are required to be covered at 100 percent by your plan. Expenses are considered separately by individual service — so expect multiple bills for inpatient (cost of physicians, hospitalization, delivery) and outpatient (OB-GYN appointments during and after pregnancy) care.
The following services may be covered by your health insurance plan:
- Ultrasound/Sonogram Exams
- Office visits with a primary care doctor, including OB-GYNs
- Prenatal care, medicine, vitamins
- Delivery (runs anywhere between $5,000 – $10,000)
- Complication costs (for Cesarean sections or premature births)
- Check ups for newborn infants
Government Assistance for Expecting Mothers
Nine months of regular doctor’s visits and delivery can get costly, so it is important to find a plan that works for you. If there is no health insurance plan in your price range, there are some government funded options to choose from.
- Medicaid: Medicaid is available for low-income individuals and families. For further questions about Medicaid services in your state, visit Medicaid.gov or our state section.
- WIC: Women, infants, and children under the age of 5 can benefit from WIC, a government-run agency advocating their needs when it comes to proper nourishment and health. These benefits are provided by the USDA/Food and Nutrition Service. For more information, visit the federal government site for the WIC Program.
- Services vary from state to state. Please consult your local department of health to research the benefits and programs offered near you. Here is a well-compiled index of local health departments: www.naccho.org/about/lhd