Under the Affordable Care Act (ACA), pregnancy and maternity care are covered as essential health benefits. Pregnancy by itself doesn’t qualify you to sign up for health coverage or make changes outside of the Open Enrollment Period. However, there may be other ways to get coverage when you’re pregnant. Learn more about how health insurance covers pregnancy, how you can get coverage while pregnant, and how to find low-cost coverage options.
Importance of health insurance for pregnant women
It is critically important for pregnant women to make sure they have health coverage. Medicaid and CHIP are popular options, but there are family plans available as well. Some of the reasons why women need to have health services while pregnant include:
- Physiology undergoes many changes while pregnant, and you need to ensure that your body has the support it needs.
- You must make sure that your baby is developing appropriately.
- If there are complications, the prognosis can be improved if you can access care sooner rather than later.
- There is a chance that emergencies can be prevented with the right medical care.
For all these reasons, you should look at your health insurance options with the help of a professional. That way, you and your unborn child receive the support you need.
The costs of pregnancy and giving birth
It can be difficult to determine exactly how much money it costs to carry a baby to term and deliver them as there are many factors that come in to play. However, according to the Kaiser Family Foundation, the average total health costs for pregnancy, childbirth, and post-partum care amount to $18,865 for women enrolled in large group plans. Out-of-pocket payments for these services average $2,854.
This includes pregnancy, childbirth, and post-partum spending. That is why most pregnant women need to have insurance that can help cover the costs.
Understanding coverage for pregnancy under health insurance
Just as medical plans by state can vary, insurance coverage can vary as well. In general, health insurance for pregnant women should include several services. They include:
- Prenatal care
- Labor and delivery care
- Coverage for a possible C-section
- Post-partum care
If you have questions about what is included in your maternity insurance, do not hesitate to reach out to a professional who can help you.
Is pregnancy considered a pre-existing condition?
Under the ACA, all Marketplace plans must cover pre-existing conditions you had before coverage started. According to Healthcare.gov, pregnancy is not considered a pre-existing condition. So if you were pregnant at the time that you applied for new health coverage:
- You can’t be denied coverage due to your pregnancy
- You can’t be charged a higher premium because of your pregnancy
- Your pregnancy and prenatal coverage starts on the first day of coverage
This hasn’t always been the case. Before the ACA, most plans on the individual market didn’t cover pregnancy, according to the National Women’s Law Center. Pregnancy was also considered a pre-existing condition. This meant insurers either denied coverage to pregnant women or charged them more.
What does health insurance cover for pregnancy?
Marketplace plans should cover all medical care related to pregnancy, childbirth, and after the baby is born.
Some covered services often include:
- Outpatient Services: Prenatal and postnatal visits to the doctor, lab tests, and medications.
- Screenings: Preventive screenings for anemia, gestational diabetes, hepatitis B, preeclampsia, STDs, and more are covered.
- Tobacco intervention and counseling for pregnant smokers or tobacco users
- Inpatient services: This includes hospitalization, emergency services, and physician fees if needed while pregnant.
- Labor and delivery services
- Newborn Care
- Lactation counseling, support, and breastfeeding equipment (including breast pumps)
Even though maternity care is an essential benefit, coverage details and costs may vary by plan. Check your plan’s summary of benefits for more info.
When can pregnant women enroll in a health insurance plan?
Pregnant women can get health insurance during the Open Enrollment Period which usually starts on November 1st of every year. While there is a Special Enrollment Period that allows you to enroll outside of that period, pregnancy isn’t usually considered a qualifying event in most states.
However, there are other life changes that may qualify you for a Special Enrollment Period:
- Birth of a child, placing a child in foster care, or adopting a child
- Getting married
- Death
- A divorce or legal separation that results in loss of coverage
- Moving to a new residence
Contact your state’s health department to learn if pregnancy is a qualifying event where you live.
Healthcare options for uninsured pregnant women
If you do not have insurance for pregnancy, you have a few options for low-cost or free maternity care. Some of the opportunities you may want to explore include:
Medicaid
Medicaid is a federal program that is administered on the state level that provides medical coverage for low-income individuals, including pregnant women. You might be able to apply for Medicaid coverage for yourself and your unborn child while pregnant. Eligibility is based on income and household size. Contact your state for more information.
As of 2024, 4 in 10 of mothers had Medicaid at the time of giving birth. By law, states have to offer Medicaid coverage for pregnancy-related care for up to 60 days after giving birth. But after those 60 days, some new moms might lose their Medicaid coverage, especially in states that haven’t expanded Medicaid. To help improve healthcare for new moms and close racial gaps in maternal health, the American Rescue Plan Act of 2021 gave states the option to extend Medicaid coverage for new moms up to 12 months after giving birth. This started on April 1, 2022, and was originally set to last for five years. But now, it’s a permanent option, thanks to the Consolidated Appropriations Act 2023. The Centers for Medicare and Medicaid Services (CMS) released instructions on December 7, 2021, to help states use this new option.
CHIP
The Children’s Health Insurance Program provides health insurance to uninsured children. Typically, CHIP is meant for families who make too much money to qualify for Medicaid but not enough money to cover their expenses. In a few states, CHIP covers pregnant women as well.
Community health centers
Community health centers also frequently open their doors to people who do not have health insurance—specifically those who are low-income. They may have grants to provide medical services to certain people who might not have health insurance, including some pregnant women. You may want to reach out to the community health centers in your area to see their available resources.
Planned Parenthood
Planned Parenthood is a comprehensive program that provides reproductive, family planning, and preventive health services to people of all backgrounds. Some Planned Parenthood locations provide pregnancy care and may use a sliding scale model for payment.
You may want to see if there is a Planned Parenthood branch in your area.
Hill-Burton facilities
Certain hospitals and clinics nationwide offer free or low-cost care as part of the Hill-Burton Program (see a full list here). Hill-Burton facilities provide free or reduced-cost health services to certain eligible populations. There are approximately 140 locations across the country, and many of them provide health services to pregnant women.
Note that you must meet income requirements to be eligible.
Charity organizations
Some charities and religious organizations, such as Catholic Charities and Lutheran Services, offer maternity and postpartum services. Services may vary by location.
Additionally, different charity organizations have different qualifications or standards that people need to meet to receive care. You may want to take a look at some of the nonprofit health organizations in your area to see if they can provide you with medical services at a price you can afford.
Find out if you qualify for self-pay rates
If you must pay for your pre- and postnatal care out-of-pocket, ask if you’re eligible for a “self-pay rate.” Some hospitals have a “self-pay” discount rate for patients with limited income.
How to find the right health insurance for pregnant women
Marketplace plans must cover maternity care as an essential health benefit. On eHealth, you can find a wide selection of individual and family health plans at different price points. We make it easy for you to find affordable care that fits your needs. If you’d like to get started, just enter your zip code into our plan finder tool to browse plan options. If you have questions, our licensed insurance agents can help you find customized coverage solutions.
Get pregnancy insurance today
Everyone deserves to have access to comprehensive medical care, and this includes pregnant women. If you are pregnant, affordable health insurance options are available. For example, you may want to learn more about the Affordable Care Act and the options that have been made available to you. eHealth can help you find health coverage at an affordable price. With our tool, you can compare the features, benefits, and costs of each individual plan, ensuring you have health coverage that is best suited to your needs.
