One of the many things you may worry about when you find out you're pregnant are your finances, and right at the top of the list comes being able to pay for prenatal care, labor, and delivery. Will your health insurance cover pregnancy? What if you don't have health insurance?
This worry is not without warrant. The United States is the country with the highest costs for childbirth in the world. On average, U.S. hospitals charged moms with employer-provided insurance about $32,000 on average for vaginal births and $51,000 for Cesarean deliveries. With such looming figures hanging over the heads of expectant parents, it's no wonder that health insurance for pregnancy and childbirth is a top-level concern.
Will my existing health insurance cover pregnancy care?
Maternity care and childbirth are considered essential health benefits, meaning that qualified health plans which are mandated by the Affordable Care Act must cover these services. If you have Marketplace insurance (also known as ObamaCare) or Medicaid, your pregnancy will be covered. Both of these types of insurance pay for all pregnancy care.
Maternity care and childbirth are considered essential health benefits.
Private insurance obtained through your employer have varying copayments and deductibles. In this case, as soon as you are planning to become pregnant, you should contact your insurance carrier directly and find out how much you will have to pay out of pocket. Get also everything in writing.
What is covered in pregnancy and maternity care?
The Affordable Care Act requires the following services to be covered:
- All prenatal care: exams, blood tests, ultrasounds, birth classes
- Any treatment that might be necessary due to a pregnancy or birth complications: cesarean section, all surgical procedures, NICU, epidurals, incubators
- Any condition that might be brought on or worsened by pregnancy such as diabetes and high blood pressure
Will my baby be covered?
All Marketplace insurance offers a special enrollment period for new babies. This coverage will be in effect from the day your baby is born. Private insurance companies follow the same rule.
I just got a new insurance and I'm already pregnant. Will I be covered?
Pregnancy is considered a preexisting condition, and the Affordable Care Act mandates that all pre-existing conditions are covered, including pregnancy. Commercial insurances may have different rules, and you have to contact the company directly, preferably before changing jobs or before pregnancy, but at the lastest when you find out that you are pregnant.
Does Medicaid cover pregnancy and childbirth?
Medicaid covers all pregnancy-related expenses as well as care for your new baby. You must meet a certain income level to be eligible. Even if you applied for Medicaid previously and were denied, you may want to apply again now that you are pregnant. Rules have changed and you may now qualify. Many clinics will help you apply for Medicaid and you should let them help you apply.
What is CHIP?
Children’s Health Insurance Program (CHIP) is another state-based medical insurance program. CHIP requires you to apply and fall within a certain income level.
Will my insurance cover all healthcare providers?
Your insurance may not necessarily cover many or all expenses. Some commercial insurance companies may pick and choose which doctors are covered in their network. If you use a healthcare provider out-of-network, you will have additional costs which you must pay. Always ask the doctor's office first before your first visit to find out if the doctor accepts fully your insurance.
- Some ObGyn doctors will charge you directly, and you are expected to pay the fee in full. You can then submit the invoice to your insurance and hopefully your insurance will reimburse you some or all of these fees.
- Other doctors may bill your insurance first, then after they received the insurance payments they may bill you the difference.
- Many doctors will fully accept your insurance payments or they are part of a network, and you may not have to pay anything in addition to what the doctor received from the insurance.
Many midwives and doulas are not covered by health insurance and expect you to pay them directly.
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