Did You Know About Pregnancy Insurance?

Welcoming a bundle of joy shouldn’t mean becoming a bundle of nerves when it comes to financial matters.

This is why it’s good to know that maternity insurance coverage is one of the 10 essential health benefits that insurance providers must cover under individual, family, and group plans. Many of the costs associated with pregnancy may be covered by your insurance, so it’s important to know the ins and outs of what’s covered and what isn’t.

Pregnancy Insurance Coverage

Pregnancy insurance can cover various costs incurred with pregnancy and childbirth, including:

• Outpatient services such as prenatal/postnatal doctor visits, ultrasounds, blood work, medications, gestational diabetes screenings
• Labor, delivery
• Inpatient services, including your hospital stay and associated physician fees
• Newborn baby care
• Breastfeeding support such as breast pump rental and lactation counseling

Some insurance plans allow you to buy supplemental insurance for your pregnancy costs. Supplemental maternity insurance coverage provides you with direct cash payments rather than sending the payments to your healthcare providers.

Additionally, you can purchase insurance policies for both hospital indemnity and short-term disability. A substitute health plan for those who can’t afford standard health insurance, hospital indemnity covers hospital expenses for labor and delivery as well as any medical care your child may require in the neonatal intensive care unit. Short-term disability serves to replace a mother’s income while she’s on maternity leave or if the mother-to-be is placed on bed rest by her doctor before the birth of her child.

Average Pregnancy Costs With Insurance

As of 2014, the Affordable Care Act (ACA) requires that insurance providers cover the costs associated with pregnancy, labor, delivery, and newborn baby care. Before the ACA went into effect, pregnancy was deemed a pre-existing condition, which meant that insurance providers could deny you coverage.

But even with insurance coverage, pregnancy costs can be considerable. In 2015, labor and delivery in the U.S. rose to more than $4,500, according to a study conducted by the University of Michigan. Cost differentials can depend on many things, including factors such as whether you need a C-section or if complications arise. Factor in surgery, and the study found that you could pay anywhere from $3,364 to $5,161, per delivery.

The study indicated that the marked increase in pregnancy-related costs was based more on rising deductibles as opposed to increasing costs. If your plan has a high deductible, you may be eligible for a health savings account (HSA), a tax-advantaged account just for medical-related expenses. Or you might want to consider looking for a plan with a higher premium that offers more expansive coverage along with a lower deductible.

Pregnancy insurance costs vary by state. To learn about how much pregnancy insurance might cost in your area visit FairHealthConsumer.org.

Insurance Options

Additional options are available for individuals who don’t have pregnancy insurance.

The Children’s Health Insurance Program  (CHIP) offers low-cost health coverage options for children of families that don’t qualify for Medicaid but who don’t earn enough to buy private insurance. Because there is no waiting period, you can count on receiving CHIP coverage as soon as you qualify

When you’re pregnant, qualifying for Medicaid becomes easier:  Many mandatory eligibility groups require that your income falls below a certain threshold as part of their guidelines, but most states allow pregnant women to qualify with a higher income than the standard.

If your income exceeds the Medicaid eligibility guidelines, consider looking into marketplace health insurance plans. With marketplace plans, certain life events allow you to qualify for a special enrollment period rather than waiting for once-a-year open enrollment. While pregnancy isn’t considered a special enrollment event, childbirth is. You can sign up for an insurance plan within 60 days of giving birth, or just 30 days if it’s an employment-based plan.