How to Get Affordable Health Insurance for Expectant Mothers

How to Get Affordable Health Insurance for Expectant Mothers

From prenatal care to infant care, every major medical insurance plan covers pregnancy. The Affordable Care Act, which went into effect in 2014, assured that all pregnancy-related services were covered, making it easier for expectant and soon-to-be mothers to get insurance.

Although it is now easier than ever to obtain pregnant health care, it is critical to understand how it works because not all pregnancies are the same and expenses vary.

(Government health insurance programs are available for pregnant women without private health insurance, and there may be discounted or free treatment options to consider.)

What Kinds of Maternity Services Are Included?

Unlike before its passage, the ACA ensured that maternity coverage was covered. Only nine states had enacted legislation requiring mandatory maternity coverage prior to 2014. Only a few policies offered the coverage, and it required a specific rider and a waiting period. Pregnancy is also considered a pre-existing illness by many insurance providers, allowing them to raise coverage premiums for expectant mothers.

Maternity coverage could be refused before to 2014, making it more difficult to pay for maternity-related expenses. Many maternity services are now covered by health plans:

  • Outpatient treatments include doctor visits, lab tests, gestational diabetes screenings, and medications, among other things.
  • Inpatient services include doctor's costs, hospitalization, surgery, and other procedures.
  • Lactation advice and supplies
  • Care for newborns

Coverage is determined by the plan chosen, which determines which benefits are covered. Copayments, deductibles, and providers all influence out-of-pocket expenditures.

How to Work Out Which Benefits Are Covered

An Overview of Benefits and Coverage document, which is a summary of what each plan offers, must be provided by health insurance carriers. Expectant or soon-to-be mothers should read the Summary to see if their plan is good for them and compare the different options to avoid being surprised by medical expenditures.

Pregnancy can no longer be considered a pre-existing condition under the Affordable Care Act, even if it occurred before coverage began.

If you have a grandfathered individual health plan – one that you obtained on your own rather than via an employer – it does not have to cover pregnancy and/or childbirth. Contact them if you want to learn more about what your health insurance company offers in terms of pregnancy and childbirth.

Is there a hospital and a doctor in your network? That's not always the case!

Most people think that a doctor who works in an in-network hospital is also in-network, but this isn't always the case. Although an in-network doctor may have hospital privileges, this does not imply that the hospital is also in-network. Many neonatal intensive care units (NICUs) are contracted with hospitals and thus out-of-network. Your anesthesiologist can be a doctor who isn't in your insurance network.

To protect yourself financially, call your health insurance carrier to find out which doctors/hospitals are in-network and which are out-of-network.

Considerations for Enrollment and Plans

Enrollment in health insurance coverage is open from November 1 to December 15, with certain jurisdictions extending the term.

Outside of this time frame, eligibility to enroll or change health insurance plans is based on a "qualifying life event," which allows for a 60-day special enrollment period to obtain new coverage.

Giving birth, not pregnancy, is considered a qualifying life event. You have 60 special enrollment days after having birth to find new coverage or keep the one you have. Make sure to look over the plans to see what perks are available, which may include, but are not limited to:

  • OBGYN coverage by a specialist
  • Coverage for labor and delivery
  • Prenatal screening (genetic testing, amniocentesis, ultrasounds)
  • Coverage of private rooms
  • Coverage for non-traditional deliveries (midwives, home births)

The cost of giving birth ranges from $30,000 for a vaginal birth to more than $50,000 for a C-section. The price will vary depending on the area and the hospital. None of these prices include ICU or NICU stays, as well as deductibles, co-pays, and other costs. It costs a lot of money to be pregnant and give birth! Here is where you should do your homework!

Although pregnancy is not a pre-existing condition, prenatal, birth and neonatal care are. It is also thought necessary for short-term health insurance, despite it is not required for major medical insurance. This type of insurance is suitable for persons who were unable to enroll in health insurance during open enrollment and who require coverage for worst-case circumstances or as a stop-gap measure.

The difficulty with this coverage is that they can reject your coverage or refuse to cover anything connected to that pre-existing disease if you have a pre-existing condition. Pregnancy is considered pre-existing coverage in short-term plans, thus anything linked to it is unlikely to be covered.

Pregnant and without health insurance?

If you become pregnant and do not have health insurance, there are certainly still options available to you.

Medicaid or CHIP (Children's Health Insurance Program) - For pregnant mothers and children who fulfill certain income requirements. Women are generally eligible for Medicaid coverage as a result of the Medicaid expansion.

If you don't have insurance and are turned down for Medicaid, there are other options, such as:

  • Planned Parenthood is a term that refers to the practice of having children
  • Departments of Public Health
  • Health Centers in the Community
  • Organizations that help people in need
  • Facilities at Hill-Burton (available in certain states)

Other strategies to cut expenditures during pregnancy include:

  • Birth Centers are a great option for low-risk mothers and are substantially less expensive than hospitals.
  • Discount Plan – This can help you save a lot of money on important services like prenatal and postpartum care.
  • Hospital Indemnity Insurance — can help with the financial planning for labor and delivery expenditures, as well as long-term hospital stays in the ICU or NICU.

The Affordable Care Act (ACA) makes it feasible to get affordable health care while pregnant, but it all comes down to selecting the perfect coverage for your growing family. Examine plans that meet your budget and provide you with the coverage you require all year. Remember, unless you have a qualifying life event, you can only enroll from November 1 to December 15.