Orlando Harmon
Pregnancy is an important time to have health insurance, as it can help you pay for medical care and ensure that your body and your baby receive the support you need. There are several options for health insurance for pregnant women, including Medicaid, the Children's Health Insurance Program (CHIP), and private insurance. If you already have insurance, you may be able to keep your current coverage and add your baby to your plan after giving birth. If you don't currently have insurance, you may be able to qualify for a Special Enrollment Period to enroll in a new plan, depending on your state and income level.
| Characteristics | Values |
|---|---|
| Current insurance plan | If you want to keep your current Marketplace coverage, do not report your pregnancy to the Marketplace. |
| Applying for Marketplace coverage | Select the “Learn more” link when asked if you’re pregnant to read tips to help you best answer this question. |
| Medicaid | If you report your pregnancy, you may be eligible for free or low-cost coverage through Medicaid. |
| Children’s Health Insurance Program (CHIP) | If you qualify for CHIP, your information will be sent to the state agency, and you won't be able to keep your Marketplace plan. CHIP provides health insurance to some children and pregnant women in families that earn too much for Medicaid but can’t afford private insurance. |
| Special Enrollment Period | Being pregnant doesn’t qualify you for a Special Enrollment Period, but the birth of a child does. |
| Tax credits | You may be able to get tax credits that help pay for insurance through your state’s Marketplace. |
| Plan summaries | Each plan has a summary that includes the expected costs of pregnancy care. |
| Employer-provided insurance | You may also have health insurance through your employer. |
| Pre-existing condition | Pregnancy is considered a pre-existing condition, which means you had the condition before you signed up for health insurance. |
| Prenatal and maternity services | All health plans must cover certain preventive care with no out-of-pocket cost to you at the time of the visit. These services include prenatal tests, breastfeeding help, and birth control. |
| Cost-sharing | Some costs you may encounter include copays (a flat fee per doctor visit) and coinsurance (a percentage of the total cost of medical care). |
| Medicaid eligibility | Eligibility for Medicaid is based on income and household size. The amount of money you can earn and still qualify varies by state. |
| CHIP Perinatal | CHIP Perinatal provides limited coverage during pregnancy and two postpartum visits within 60 days of the end of the pregnancy for women who can't get Medicaid and don't have health insurance. |
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What You'll Learn
Medicaid and CHIP coverage
Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities. In all states, Medicaid provides coverage for low-income people, including families and children, pregnant women, the elderly, and people with disabilities.
Medicaid benefits are different in each state, but all states provide comprehensive coverage. In certain states, CHIP provides low-cost health coverage to children and pregnant women in families that earn too much money to qualify for Medicaid. Each state works closely with its state Medicaid program. In many cases, if you qualify for savings on a Marketplace plan, your children will qualify for either Medicaid or CHIP.
Pregnant women might be able to get free health coverage during their pregnancy through Medicaid for Pregnant Women or the Children's Health Insurance Program (CHIP) Perinatal program. To get Medicaid for Pregnant Women or CHIP Perinatal, you must be a Texas resident and a U.S. citizen or qualified non-citizen. If you have other health insurance, you are not eligible for the CHIP Perinatal program. When you apply, you will be asked about your family's monthly income to see if you can get Medicaid or CHIP Perinatal.
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) included a new option for states to provide Medicaid and CHIP coverage to children and pregnant individuals who are lawfully residing in the United States, including those within their first five years of having certain legal status.
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Employer-provided insurance
If you have employer-provided insurance, you must enrol in a health plan during the open enrolment period set by your employer. However, having a baby qualifies you for a special open enrolment period, during which you can add your baby to your policy. Many employers require you to add your baby to your policy within 30 days.
If you are pregnant and want to apply for employer-provided insurance, you may be able to do so during a special open enrolment period if you have experienced a "qualifying life event". This could include losing other health coverage or moving to a new state. Pregnancy alone does not qualify as a life event, but you can still apply for coverage during the regular open enrolment period.
If you already have employer-provided insurance when you become pregnant, you are entitled to maternity care and newborn care services before and after your child is born. These services are considered essential health benefits under the Affordable Care Act (ACA). All qualified health plans must meet the ACA requirement for "minimum essential coverage". This includes coverage for prenatal care visits with no copay, meaning you won't have to pay your healthcare provider each time you go for a prenatal checkup.
Depending on your income, your child may qualify for Medicaid or the Children's Health Insurance Program (CHIP) even if you have employer-provided insurance. You can apply for Medicaid or CHIP at any time during the year, and your coverage can begin immediately if you are eligible. However, it's important to note that eligibility criteria vary by state, so be sure to check with your state agency for specific rules and benefits.
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Marketplace plans
If you are looking to apply for insurance while pregnant, you may be able to get coverage through a Marketplace plan. The Health Insurance Marketplace is an online resource that helps you find and compare health plans in your state.
If you already have Marketplace coverage and want to keep it, you don't need to report your pregnancy to the Marketplace. However, if you report your pregnancy, you may be eligible for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). If you are found eligible for these programs, you will not be able to keep your Marketplace plan.
After your baby is born, you can enroll in a Marketplace plan even if it is outside the Open Enrollment Period. This is known as a Special Enrollment Period, and you must apply within 60 days of your baby's birth. Your plan can cover you, your baby, and any other household members.
Depending on your income and state of residence, you may qualify for Medicaid, which provides free or low-cost health coverage for pregnant women. Each state has different income eligibility requirements for Medicaid, so be sure to check with your state to understand your options.
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Cost-sharing and copays
Pregnancy is a high-cost health expense, even for women with health insurance. It is important to understand the various health insurance terms to keep your overall costs as low as possible.
Cost-sharing refers to deductibles, copayments, and out-of-pocket maximum amounts. These are the costs that you will need to pay out of your own pocket.
The deductible is the amount you pay before your health plan starts paying some share of the expenses. For example, if your deductible is $3,000, you will pay for co-insurance out-of-pocket until you hit that $3,000 limit; at that point, your health insurance starts paying for some of the expenses up to your out-of-pocket maximum, when they will pay for everything.
The out-of-pocket maximum is the most you will pay for covered services in a plan year. This amount does not include your monthly premiums but does include co-pays and coinsurance that you continue to pay after you hit the deductible.
On average, pregnant women enrolled in large employer health plans incur $2,854 more in out-of-pocket costs than women who are not pregnant. These costs are more than many families can afford. About half of people who give birth in a given year are covered by private insurance, and the remainder are mostly covered by Medicaid, which generally has little or no out-of-pocket liability.
If your income qualifies you for Medicaid, you can enrol at any time during the year and receive free or low-cost coverage. Similarly, the Children's Health Insurance Program (CHIP) provides free or low-cost health coverage to millions of Americans, including some low-income people, families, children, and pregnant women.
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Prenatal and maternity services
If you are in the United States, you may be eligible for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). All states offer Medicaid coverage to pregnant women whose income makes them eligible. The amount of money you can earn and still qualify varies by state, but in 2024, most states offered coverage to pregnant women with incomes up to or over 185% of the federal poverty level (roughly $27,861 for an individual).
Medicaid coverage for pregnant women includes the full array of Medicaid services, as well as prenatal doctor visits, prenatal vitamins, labor and delivery, and checkups and other benefits for the baby after leaving the hospital. Coverage continues through pregnancy, labor, delivery, and the first 60 days after birth. If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year.
If you don't qualify for Medicaid, you may be eligible for CHIP Perinatal, which provides limited coverage during pregnancy and two postpartum visits within 60 days of the end of the pregnancy for women who can't get Medicaid and don't have health insurance.
If you have private insurance, you should carefully review your health plan's summary of benefits to see what prenatal and maternity services are covered and whether your preferred obstetrician and hospital are in the plan's network. All health plans must cover certain preventive care with no out-of-pocket cost at the time of the visit, including:
- Testing and counseling for sexually transmitted diseases, including HIV
- Testing for a blood condition known as Rh incompatibility
- Folic acid supplements (with a prescription)
- A wide range of prenatal tests, including anemia screening and screening for urinary tract infections
Most health plans will cover much of the costs of delivery and aftercare, but you may need to pay part of the bill.
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Frequently asked questions
You can apply for Medicaid coverage for yourself and your unborn child while pregnant. Eligibility is based on income and household size. You can also apply for the Children's Health Insurance Program (CHIP).
Medicaid and CHIP provide free or low-cost health coverage to millions of Americans, including some low-income people, families, children, and pregnant women.
Yes, you can be pregnant when you sign up for health insurance. Insurance companies cannot deny you coverage or charge you more money to care for pre-existing conditions.
You can keep your current Marketplace coverage and update the application after you give birth to add the baby to the plan.
