Health Insurance Options for the Pregnant or Soon-to-Be-Pregnant
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 pregnant. Those who are pregnant need constant medical attention for themselves and their unborn babies from the moment of conception, including prenatal care, delivery, and follow-up postnatal care.
This medical care is often costly, and finding the best health insurance for pregnancy can seem overwhelming. When looking for health insurance while pregnant, here are some questions to consider:
- Does the policy cover prenatal care?
- Do I need a referral from my primary care doctor to see a specialist/OBGYN?
- Are labor/delivery costs covered?
- What are the copays, coinsurance, and deductible amounts?
- Is prenatal testing covered (ultrasounds, amniocentesis, genetic tests)?
- How long after delivery is my hospital stay covered?
- Will I need pre-authorization to receive prenatal care?
- What hospitals and doctor’s offices are within the preferred provider network?
- Are non-traditional deliveries covered (midwife, home birth, 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 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 need specialty prenatal care/testing, the costs could increase. Here is a breakdown of some of the expenses you can expect from 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 as much as $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 up to a few hundred dollars or more if not covered by insurance.
- Labor and 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 those 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 exactly what must be covered, so you are likely to find different coverage options depending on the insurance company.
Get several estimates before finalizing coverage so you can compare plans and avoid surprises about the type of coverage included in your health insurance 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
If you do not have maternity insurance through the insurance marketplace or through your employer, you can apply for coverage through 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 and low-income adults and children can qualify for benefits. Eligibility requirements vary by state. You can also apply by completing a Health Insurance Marketplace application.
Discount plans like AmeriPlan are alternatives to maternity insurance and can reduce maternity health insurance costs by as much as 50%. This discount plan is available in all states except Alaska, Montana, North Dakota, Rhode Island, South Dakota, Vermont, Washington, Utah, 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 options available to you. Your hospital may offer charity programs or you can talk to your hospital and explain that you will be paying for the 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 Nov. 29, 2020.
Health Care Cost Institute. "Understanding Variation in Spending on Childbirth Among the Commercially Insured." Accessed Nov. 29, 2020.
HealthCare.gov. "What Marketplace Health Insurance Plans Cover." Accessed Nov. 29, 2020.
HealthCare.gov. "Coverage for Pre-Existing Conditions." Accessed Nov. 29, 2020.
HealthCare.gov. "Health Coverage if You're Pregnant or Plan to Get Pregnant." Accessed Nov. 29, 2020.
AmeriPlan. "Disclaimer." Accessed Nov. 29, 2020.