Health Insurance Options for Pregnant or Soon-to-Be-Pregnant Moms
One of the biggest expenses associated with having a baby is prenatal health care. While it is always important to have adequate health insurance, the need becomes more pressing when a woman is pregnant. Women need constant medical attention for themselves and their unborn babies from the moment of conception, through prenatal care, then delivery, and finally all the way to follow-up postnatal care. This medical care is often costly and finding adequate health insurance to cover you and your unborn child can seem overwhelming. If you are a pregnant mother to be or are just considering becoming pregnant, you may be wondering what health insurance options are available to you. When looking for health insurance while pregnant, here are some questions to consider:
- Does the policy cover prenatal care?
- Do I need a referral to see a specialist/OBGYN from my primary care doctor?
- Are labor/delivery costs included?
- What are the copays, coinsurance, and deductible amounts?
- Is prenatal testing covered (ultrasounds, amniocentesis, genetic tests)?
- How longer after delivery is my hospital stayed covered?
- Will I need preauthorization to receive prenatal care?
- What hospitals and doctor’s offices are within the preferred provider network?
- Are non-traditional deliveries covered (midwife, homebirth, etc.)?
- Are private rooms covered or will I have to share a room?
Here is a brief run-down on coverage options and costs. Prices and coverage options will vary based on your state of residence and your insurer.
The first step in finding adequate health insurance for pregnancy/childbirth expenses is to get an idea of what the kind of expenses to expect. This will vary greatly depending on the particular services you receive and the part of the country you live in. If you have to have specialty prenatal care/testing, the costs could go way up. Here is a breakdown of some of the expenses you can expect through pregnancy to childbirth (this list is not all-inclusive and will vary based on each individual’s particular health needs).
- First Trimester: During your first trimester (months 1-3) common charges will include monthly doctor visits, lab work, ultrasounds, prenatal vitamins and any additional testing deemed necessary (DNA testing, CVS sampling for high risk pregnancies).
- Second Trimester: During your second trimester (months 4-6) you will continue with monthly prenatal visits and have some additional lab work completed including glucose screening (to check for gestational diabetes) and maternal blood screening (checks your blood for evidence of genetic defects). If your obstetrician suspects any abnormalities, you may also be scheduled for amniocentesis (this could cost about $2,800). Additional ultrasound tests will also be performed to make sure your baby is developing normally throughout the pregnancy.
- Third Trimester: By the third trimester (months 7-9), many of the necessary blood work and genetic testing has been completed so you may only have to pay for your regular OB visits, which may be scheduled weekly by this stage of your pregnancy. You may also take birthing classes which can cost a few hundred dollars or more if not covered by insurance.
- Labor/Delivery: Labor and delivery charges are tricky to try and calculate in advance because you never know if you are going to have a normal vaginal delivery with no complications (charges could be as low as $7,507 in Arkansas) or end up having a C-Section (charges can be as high as $26,675 in Oregon). These figures are for women who are insured.
Coverage through the Affordable Care Act (ACA) 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 policies according to ACA guidelines. You can apply for health insurance through the ACA insurance marketplace. However, the Affordable Care Act (ACA) does not define what must be covered so you are likely to find very different coverage options depending on the insurance company. Get several estimates before finalizing coverage so you can compare plans and won’t have any surprises in the end about the type of coverage included in your health insurance plan. You can’t be denied coverage because of a pre-existing condition and pregnancy is a pre-existing condition accord to health care law.
Medicaid or CHIP Maternity/Childbirth Coverage
If you do not have maternity insurance through the insurance marketplace or through your employer, you can apply for coverage through Medicaid or CHIP. Prenatal and childbirth costs are covered by Medicaid and by Children’s Health Insurance Program (CHIP). These programs are run by the individual states and low-income women and children can qualify for benefits. Eligibility requirements vary by state. You can learn more about qualification for Medicaid and CHIP healthcare coverage and see if you qualify. You can also apply by completing an insurance marketplace application.
Discount plans, such as AmeriPlan are alternatives to maternity insurance and can reduce the cost of maternity health insurance costs by as much as 50 percent. This discount plan is available is all states with the exception of Alaska, Montana, North Dakota, South Dakota, Vermont and Wyoming. With a medical discount plan, you pay a monthly fee to receive discounts on specific medical services and products from participating healthcare providers.
If you are unable to find insurance, you still have some options available to you. Your hospital may charity programs available or you can talk to your hospital and explain that you will be paying for maternity/childbirth costs yourself. Many hospitals offer discounts to cash paying customers and to those without insurance.
Connecticut Health I-Team. "Early Pregnancy Blood Test Reducing Need For Amniocentesis." Accessed July 27, 2020.
Augusta Health. "Childbirth & Prenatal Classes." Accessed July 27, 2020.
Health Care Cost Institute. "Understanding Variation in Spending on Childbirth Among the Commercially Insured." Accessed July 27, 2020.
U.S. Centers for Medicare & Medicaid Services. "What Marketplace Health Insurance Plans Cover." Accessed July 27, 2020.
U.S. Centers for Medicare and Medicaid Services. "Coverage for Pre-Existing Conditions." Accessed July 27, 2020.
U.S. Centers for Medicare and Medicaid Services. "Health Coverage if You're Pregnant or Plan to Get Pregnant." Accessed July 27, 2020.