Maternity care and childbirth are considered essential health benefits. That means all health insurances and Medicaid plans have to cover both of them, even if the pregnancy has started before the coverage takes effect. It became mandatory in 2014, under the Affordable Care Act ( ACA). Before that, pregnancy was considered a pre-existing condition and could make things more difficult.
Enrolling in a Plan While Pregnant
The ACA makes it easier for pregnant women to find an insurance plan and get the proper health care during their pregnancy. Under the health care law, it is mandatory that health insurance plans cover pre-existing conditions, including pregnancy. Isurance companies can’t increase their prices or turn a client down because she is pregnant.
The insurance company also has to cover check-ups, routine and emergency care and hospital procedures. The rules are valid whether you pay a health insurance on your own or through an employer.
It’s important to contact the company and be aware of what they cover during pregnancy since it can be different in each plan. However, grandfathered health plans, those created before March 23, 2010, don’t have to cover pregnancy and childbirth.
Spousal insurance follows the same rules assured by ACA. Even if your partner's pregnancy had started before she enrolled in health insurance, she would be automatically covered by it.
There is no legal need to notify the health insurance company about the pregnancy. However, after the birth, you have 60 days to add the baby’s name to the policy. Otherwise, you will have to wait until the next enrollment period.
Carefully Review the Plan
Before enrolling in a health insurance plan, it is essential to read the plan’s full summary of benefits and check if they have all the services you need. Also, check the list of providers they offer, especially hospitals and doctors.
Understand how much your deductible will be and all your out-of-pocket expenses.
The government also has a program that covers maternity and childbirth, designed for low-income families. According to the Health Care website, Medicaid and Children’s Health Insurance Program (CHIP) have different rules and benefits in each state.
Pregnant women can send their application any time of the year, not only during the Marketplace Open Enrollment. The request can be made online or at a state agency.
The Medicaid plan is available up to 60 days after the delivery of your baby. However, it's possible to find insurance options through state or private companies.
Open Enrollment Period and Life Events
The open enrollment period is the time of the year when people can enroll in a health insurance plan. However, if you have a life event it's possible to have a special open enrollment period. Although the list of special events doesn’t include pregnancy, having a baby or adopting a child is.
- How to Be Covered Under Health Insurance When Changing Jobs
- Copay vs. No Copay
- Definition of Out-of-Pocket Maximum & Deductible
- Tertiary Insurance Definition
- Preexisting Medical Problems and Health Insurance Plans
- HRA Vs. OAP Insurance
- Why Would You Want to Pay for Your Own Health Insurance?
- Insurance Rules on Coordination of Benefits