Health Insurance Options for the Pregnant or Soon-to-Be-Pregnant

Pregnant African American mother using digital tablet in bed
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One of the biggest costs you'll run into when you have a baby is health care. Health care before your baby is born is called prenatal care. Care after your baby is born is postnatal health care.

You should always have health insurance to protect both your health and your bank account. But the need becomes more pressing when you are pregnant. 

If you're pregnant, you need regular care for yourself and your unborn baby. This includes prenatal care, birth and delivery, and postnatal care to follow up after your baby is born.

Key Takeaways

  • If you're pregnant or planning to become pregnant, you should look over your current health insurance to see what it covers for pregnancy and birth.
  • Keep in mind that you will need prenatal care, delivery, and postnatal care.
  • Maternity care is one of the 10 essential benefits that must be part of all health care plans under the ACA, but what is covered can very between plans.
  • If you do not have maternity insurance through the marketplace or through work, you can apply for Medicaid or CHIP.

What Should You Ask About Your Health Plan?

Prenatal medical care is often costly. Finding the best health insurance for pregnancy can take a lot of time and effort. 

When looking for health insurance for your pregnancy, here are some questions to think about:

  • Does the plan cover prenatal care?
  • Do I need a referral from my primary care doctor to see a specialist or OBGYN?
  • Are labor and delivery costs covered?
  • What are the copays, coinsurance, and deductible amounts?
  • Is prenatal testing covered, such as ultrasounds, amniocentesis, or genetic tests?
  • How long after I give birth is my hospital stay covered?
  • Will I need pre-authorization to receive prenatal care?
  • What hospitals and doctor’s offices are in my plan's network?
  • Are non-traditional deliveries covered, such as a midwife or home birth?
  • Are private rooms covered, or will I have to share a room?

What you'll pay for care, and what your plan will cover, will vary based on the state where you live and your insurer. Even if you think you know what is part of your plan, you can avoid surprise bills if you talk to your insurer about what is covered.

What Expenses Can You Expect During Pregnancy?

The first step in finding health insurance for your pregnancy is to know what kind of expenses to expect. This will vary based on the services you receive and the part of the country you live in.

If you need specialty prenatal care or testing, the costs could increase. But some of the expenses you can expect from pregnancy to childbirth are fairly standard.

First trimester

Your first trimester is during months one to three of your pregnancy. Common charges during this time will include monthly doctor visits, lab work, ultrasounds, and prenatal vitamins.

Your doctor may also suggest other testing, such as DNA testing or CVS sampling. These are more common for high-risk pregnancies.

Second trimester

Your second trimester is during months dour to six. During these months, you will keep up with prenatal visits every four weeks.

You often will have some more lab work done. This can include glucose screening (to check for gestational diabetes) and maternal blood screening (to check the risk of genetic defects).

If your doctor suspects any abnormalities, you may also be scheduled for amniocentesis. This test can cost as much as $2,800. 

You will also have an ultrasound test halfway through your pregnancy at 20 weeks. This is a full anatomy scan to make sure your baby's organs, skeleton, and more are developing normally.

Third trimester

The third trimester is months seven through nine. By this point, most of the standard blood work and genetic tests have been completed. You may only have to pay for visits with your doctor or midwife.

These visits will be more frequent, often every two weeks, and then each week during the last month. You may also take birthing classes. These can cost a few hundred dollars or more if not covered by insurance.

Many hospitals offer birth and breastfeeding classes for free or for a very low cost.

Labor and delivery

Labor and delivery charges are tricky to calculate ahead of time. This is because you and your doctor will not know ahead of time what kind of delivery you will have.

If you have a normal vaginal delivery with no complications, charges could be as low as $7,507. If you have a C-section, it could cost as much as $26,765.

If you have insurance, your plan should cover part of these costs. But you may not know how much is covered until after you have left the hospital and get your first bill.

Coverage Through the Insurance Marketplace

Maternity care is one of the 10 essential health care benefits that must be included in all new individual and small group health plans. This is required by the Affordable Care Act (ACA).

You can apply for health insurance through the ACA insurance marketplace to find a plan with maternity coverage. But the ACA does not define what must be covered. This means you may find that coverage options vary depending on the insurer. 

If you are looking for a new health plan, get more than one estimate before signing up. This will let you compare plans and avoid surprises about the type of coverage included in your health plan.

You can’t be denied coverage because of a preexisting condition, and pregnancy is a preexisting condition according to health care law.

Medicaid or CHIP Maternity/Childbirth Coverage

You may not have maternity insurance through work or be able to afford it through the insurance marketplace. In that case, you can apply for Medicaid or the Children's Health Insurance Program (CHIP).

Prenatal and childbirth costs are covered by Medicaid and CHIP. These programs are run by the individual states.

Low-income adults and children can qualify for benefits. Eligibility requirements vary by state. You can also apply with a Health Insurance Marketplace application.

Are There Discount Plans?

Discount plans like AmeriPlan are alternatives to maternity insurance. These can reduce maternity health insurance costs by as much as 50%.

With a medical discount plan, you pay a monthly fee to receive discounts on specific medical services and products from participating healthcare providers. AmeriPlan is available in all states except Alaska, Montana, North Dakota, Rhode Island, South Dakota, Vermont, Washington, Utah, and Wyoming. 

What If You Don't Have Insurance?

If you are unable to find insurance, there are still have options you can look into. Your hospital may offer charity programs. You can also talk to your hospital and explain that you will be paying out-of-pocket.

Many hospitals offer discounts if you pay with cash or don't have insurance. You can also talk to your provider. They may offer financing or a payment plan if you cannot pay your bills all at once.