Bringing a new life into the world is an incredible and life-changing experience. However, it also comes with its own set of financial considerations.
Many people wonder if insurance can help with the costs associated with childbirth. This is a question that can have a significant impact on your financial peace of mind during this exciting journey.
Our article explores insurance coverage for childbirth in a way that’s easy to understand, whether you’re an expectant parent, planning to start a family, or just curious about how insurance can play a role in this critical life event.
If you’re going the conventional hospital birth route or are keen on home birth, you’ll find all you need to know right here.
Does Insurance Cover Pregnancy And Childbirth?
Most health insurance covers maternity services and childbirth. All major medical insurance plans on the ACA marketplace, from individual to family and group plans, must cover pregnancy and childbirth. And all new plans subject to the Affordable Care Act’s health reforms will do so.
Plans that were signed up for before the Act didn’t necessarily offer such benefits. But if you sign up for any new health insurance plan under the ACA, you will be covered for maternity and childbirth.
The exact scope of these benefits and coverage differs from one insurance provider or health plan to the next. The details of a health plan can also depend on the state of residence. But despite slight differences, you’ll always be covered for childbirth.
What about other health insurance, like the federal program for low-income individuals and families – Medicaid? The ACA was primarily formulated to expand Medicaid services and shares much in common with it. Thus, Medicaid also offers coverage for pregnancy services and childbirth.
Maternity & Childbirth Under The ACA
Pregnancy and childbirth are listed under the essential benefits that all ACA plans must offer. This applies to all pregnancies, even if they started before your coverage. However, that was not the case before the ACA was signed into law in 2010 or even in the early years after it was introduced.
In the past, maternity coverage wasn’t guaranteed. Only nine states required maternity coverage before 2014. Approximately 12% of individual health insurance plans listed pregnancy as an included benefit.
But times have changed. According to the National Women’s Law Center, ACA plans must now offer breastfeeding benefits like breast pumps. These benefits are available without cost-sharing payments like deductibles, copayments, or coinsurance.
Does Pregnancy Qualify You For Special Enrollment?
You must sign up for ACA plans in the dedicated enrollment period, called Open Enrollment. In most states, this runs from the 1st of November to the 15th of January every year.
But you might be unable to sign up during the period due to a serious accident, death in the family, natural disaster, or another life event. Fortunately, such circumstances make you eligible for special enrollment.
Pregnancy does not qualify you for special enrollment unless you were hospitalized for complications during the open enrollment period. It will be up to you to apply for a special enrollment with proof that you were incapacitated at the time.
However, giving birth does qualify you for special enrollment. If you give birth to your baby outside of the open enrollment period, you should be able to enroll for healthcare coverage under special enrollment.
