If you’re pregnant or planning to have a baby in the next year, you’ll be seeing the doctor a whole lot more often. And giving birth, even with no complications, can be quite expensive! The good news is, maternity care and birth are considered essential health benefits, which means all individual health insurance plans are required to cover them. How much you'll spend depends on your plan.
Why should I get health insurance during pregnancy?
Having health insurance can considerably lower how much you’ll pay in maternity care and birth costs. Your plan's out-of-pocket max limits your expenses, no matter how much care you need. If your out-of-pocket max with your Bronze plan is $6850, that's the most you could spend on covered health care during the year. The costs for pregnancy and childbirth can mount into the tens of thousands of dollars without insurance.
How should I choose a health insurance plan during pregnancy?
The health insurance that works for you in a normal, healthy year might end up costing you a lot of money in medical bills, copays, or coinsurance related to your pregnancy and the birth of your child. If you plan ahead and choose a health insurance plan with your pregnancy-related costs in mind, you might save in the long run by going with a more expensive plan that has a lower out-of-pocket maximum like a Gold or Platinum plan. If you qualify for a cost-sharing reduction subsidy, you may find a Silver plan with a low out-of-pocket max. Get a quote to see if you qualify.
Which plan saves you the most?
The best way to tell which plan will save you the most this year is to imagine you're going to hit your out-of-pocket maximum and tally up your spending, including 12 months of premiums.
A Silver plan that costs $431 per month will cost you $5,172 for the year. If you spend $7,150 on medical bills to hit your out-of-pocket max, your total spending equals: $12,322.
A Platinum plan that costs $628 per month will cost you $7,536 for the year. If you spend another $1500 to hit your out-of-pocket max, your total spending comes to: $9,036.
So even though it's a lot more expensive per month, you'd save over $3,000 on a Platinum plan compared to a Silver plan! As a rule, the plan with the lowest out-of-pocket max often saves you the most when you know you're going to have a lot of medical bills in a given year. After your baby is born, you can add your newborn to your plan and switch to a less expensive plan with a higher deductible if you don’t typically go to the doctor very often.
Pro tip: If you qualify for a cost-sharing reduction, you can find Silver plans with low deductibles and reduced out-of-pocket maximums. In some cases, a Silver plan might be the most affordable option for you.
How do I sign up for health insurance during pregnancy?
With the exception of New York, pregnancy itself is not considered a qualifying life event that allows you to enroll for an individual health insurance plan outside of Open Enrollment. However, if you're uninsured and your due date is in the following year, it’s smart to sign up for a plan during Open Enrollment to keep your health care costs under control.
Do I qualify for Medicaid and CHIP during pregnancy?
If you qualify for Medicaid or CHIP, you can enroll at any time of the year. Both state-based programs provide low-cost or free health care to pregnant women. Visit HealthCare.gov to see if you qualify. You can apply through the Marketplace or directly through your state’s Medicaid website.
What's covered when you're pregnant?
Under the Affordable Care Act, your individual health insurance plan is required to cover many maternity services, including:
- Prenatal and postnatal doctor visits.
- Some screenings and tests.
- Breast pump rental.
Your health insurance plan must also offer some preventative services without copays or coinsurance, even if you haven’t met your deductible. That means the following are available to pregnant women for free:
- Folic acid supplements.
- Hepatitis B screening at your first visit.
- Anemia (a.k.a. iron deficiency, which is more common during pregnancy screenings).
- Urinary tract infection (UTI) screenings.
- Gestational diabetes screening between weeks 24 to 28 of pregnancy.
- Rh incompatibility screening and follow-up testing for those at risk.
- Tobacco education and counseling.
Once your baby is born, he or she will get routine newborn preventative care, and you’ll get breastfeeding support from a trained lactation consultant for free as well. Remember, you’ll need to visit doctors and hospitals that take your insurance to ensure your plan covers these costs (except in certain emergency situations).