Jane Dotson
Pregnancy is an expensive time, with the average total health costs for pregnancy, childbirth, and postpartum care amounting to $18,865 for women enrolled in large group plans, and out-of-pocket payments averaging $2,854. For this reason, it is important to explore your options for medical insurance. If you are in employment, you may be able to get pregnancy insurance through your employer. If not, you can find an insurance plan through the Marketplace, or apply for Medicaid and/or CHIP, which provide free or low-cost health coverage to millions of Americans, including pregnant women.
| Characteristics | Values |
|---|---|
| Pregnancy insurance options | Medicaid, CHIP, Marketplace plans, or private health insurance plans |
| Medicaid eligibility | Income, household size, and citizenship or immigration status |
| CHIP eligibility | Income, household size, and citizenship or immigration status |
| Medicaid coverage | Full health care benefits during pregnancy and for one year after the baby's birth, dental benefits, breast pumps, and breastfeeding support |
| CHIP coverage | Health coverage for children |
| Marketplace plans coverage | All medical care related to pregnancy, childbirth, and after the baby is born, including outpatient services, screenings, and inpatient services |
| Private health insurance plans | May be an option after the 12-month postpartum coverage period ends |
| Average total health costs for pregnancy, childbirth, and postpartum care | $18,865 for women enrolled in large group plans |
| Out-of-pocket payments for pregnancy, childbirth, and postpartum care | $2,854 on average |
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What You'll Learn
Pregnancy insurance options: Medicaid, CHIP, and Marketplace plans
Pregnancy is a qualifying life event that allows you to make changes to your health insurance plan outside of the open enrollment period. Here are some insurance options available to you during pregnancy:
Medicaid
Medicaid provides free or low-cost health coverage to millions of Americans, including some low-income people, families, children, pregnant women, the elderly, and people with disabilities. Each state has its own rules and benefits, and some states have expanded their Medicaid programs to cover all people below certain income levels. To qualify for Medicaid, you must be a US citizen or qualified non-citizen, and your income must be the same or less than the amount listed for your family size. You can apply for or re-enroll in Medicaid at any time during the year.
Children's Health Insurance Program (CHIP)
CHIP provides free or low-cost health coverage to those who do not qualify for Medicaid. CHIP Perinatal, for example, offers limited coverage during pregnancy and two postpartum visits within 60 days of the end of the pregnancy. To qualify for CHIP, your income must be the same or less than the amount listed for your family size. However, you cannot have other health insurance to be eligible for CHIP. Like Medicaid, you can apply for CHIP at any time during the year.
Marketplace Plans
Marketplace plans are certified by the Health Insurance Marketplace and provide essential health benefits, including maternity and newborn care. These plans follow established limits on cost-sharing, such as deductibles, copayments, and out-of-pocket maximum amounts. If you already have a Marketplace plan and become pregnant, you can keep your coverage and update the application after giving birth to add the baby to the plan. However, if you report your pregnancy, you may be eligible for more affordable coverage through Medicaid or CHIP, and you will not be able to keep your Marketplace plan.
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Maternity and childbirth health benefits
Medicaid
Medicaid is a federal program that is administered at the state level and provides medical coverage for low-income individuals, including pregnant women. Eligibility is based on income and household size, and specific rules and benefits vary by state. Medicaid provides full health care benefits during pregnancy and for one year after the baby's birth. It may also cover the three months before enrolment and includes dental benefits.
CHIP (Children's Health Insurance Program)
CHIP provides free or low-cost health coverage to millions of Americans, including pregnant women. Eligibility is based on household size, income, and citizenship or immigration status, and specific rules and benefits vary by state.
Marketplace plans
All Marketplace plans should cover pregnancy and childbirth and are required to do so under the Affordable Care Act. These plans cover essential health benefits, including services provided before and after the birth of your child, and follow established limits on cost-sharing.
Private health insurance plans
If you do not have coverage through an employer, Medicaid, CHIP, or a Marketplace plan, you can consider a private health insurance plan. These plans can be purchased through the health insurance Marketplace and may offer financial assistance to help lower the cost of coverage and care.
It is important to note that insurance coverage and costs may vary by plan and state, so it is recommended to consult with a professional to determine the best option for your specific needs.
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Eligibility requirements: income, household size, and citizenship
Income, household size, and citizenship are key factors in determining eligibility for pregnancy health insurance coverage.
Income
Pregnant women with an annual household income below 100% of the Federal Poverty Level (FPL) may qualify for premium tax credits and savings on Marketplace coverage if they meet other eligibility requirements. Those with an annual income at or below 150% FPL who are not eligible for Medicaid or the Children's Health Insurance Program (CHIP) may be able to enroll in Marketplace coverage through a Special Enrollment Period.
Household Size
Eligibility for Medicaid and CHIP takes into account your household size. These programs can provide free or low-cost health coverage to families and children, in addition to pregnant women.
Citizenship
Citizenship or immigration status is another factor that affects eligibility for health coverage. "Qualified non-citizens," including Lawful Permanent Residents (LPRs) or green card holders, may be eligible for coverage through Medicaid and CHIP if they meet state income and residency rules. However, there is typically a 5-year waiting period for many qualified non-citizens to access these benefits.
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Pregnancy expenses and insurance coverage
Pregnancy expenses can be high, especially in the United States, where labour and delivery are among the most expensive healthcare costs. Without insurance, these costs can run into the tens of thousands. However, there are several options for insurance coverage to help minimise these expenses.
Firstly, all Marketplace and Medicaid plans cover pregnancy and childbirth, including maternity and newborn care services provided before and after birth. This is true even if your pregnancy begins before your coverage starts. To be eligible for Medicaid, your income must fall below a certain threshold, which varies by state. If you are eligible for Medicaid, your coverage can begin at any time, and you can apply directly through your state agency or by filling out a Marketplace application.
If you have health insurance through your employer, it is important to determine whether your plan is grandfathered, as these plans are not obligated to provide maternity and childbirth benefits. Contact your insurance company to understand exactly what is covered and what your out-of-pocket costs will be. Compare different plans to find the most cost-effective option.
If you do not have coverage through your employer or the Marketplace, you can apply for the Children's Health Insurance Program (CHIP). Like Medicaid, CHIP provides free or low-cost health coverage to millions of Americans, including pregnant women, and eligibility is based on income requirements. You can apply for CHIP at any time during the year, either through your state agency or by filling out a Marketplace application.
To minimise costs, you can also consider giving birth at a birthing centre rather than a hospital, as this can reduce the cost of delivery and prenatal care by half. Many hospitals also offer payment plans or sliding scales to help cover the cost of pregnancy and delivery.
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Applying for pregnancy insurance: timing and process
The cost of pregnancy, childbirth, and postpartum care can be high, and insurance can help cover these expenses. If you are pregnant and do not have medical insurance, you can apply for pregnancy insurance. Here is some information on the timing and process of applying for pregnancy insurance:
Timing:
- Open Enrollment Period: The Open Enrollment Period is when anyone can sign up for a new health insurance plan. It usually starts on November 1st each year, and you can enroll in a Marketplace plan during this time.
- Special Enrollment Period: If you have recently had a baby, you may be eligible for a Special Enrollment Period. You can apply within 60 days of your child's birth.
- Anytime Enrollment: If you are applying for Medicaid or the Children's Health Insurance Program (CHIP), you can apply at any time during the year and are not restricted by the Open Enrollment Period.
Process:
- Employer-provided insurance: If you have medical coverage through your employer, contact your HR department or insurance company to understand your maternity coverage options.
- Marketplace insurance: If you do not have coverage through your employer, you can apply for a plan through the Health Insurance Marketplace. Visit www.healthcare.gov to learn more about Marketplace plans and how to apply.
- Medicaid and CHIP: If you meet certain income and household size requirements, you may be eligible for free or low-cost coverage through Medicaid or CHIP. You can apply for these programs at any time by contacting your state agency or filling out a Marketplace application and indicating that you need help paying for coverage.
- Discount services: Some organizations, like AmeriPlan, offer discount plans that can reduce the cost of healthcare services.
It is important to note that insurance plans and eligibility requirements can vary by state. Therefore, it is recommended to consult with a professional to understand your specific options and choose the best plan for your needs.
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Frequently asked questions
Some options for getting medical insurance for pregnancy include Medicaid, the Children's Health Insurance Program (CHIP), and Marketplace plans.
Medicaid is a federal program administered at the state level that provides medical coverage for low-income individuals, including pregnant women. Eligibility is based on income, household size, and citizenship or immigration status.
CHIP is a program that provides free or low-cost health coverage to children and pregnant women, among others. Like Medicaid, eligibility for CHIP is based on income, household size, and citizenship or immigration status.
You can visit www.healthcare.gov to learn more about getting health coverage through the Marketplace. It is important to note that some Marketplace plans may require you to request pregnancy coverage as an addition.
Medical insurance for pregnancy typically covers prenatal and postnatal care, including doctor's visits, lab tests, medications, and preventive screenings. It may also cover dental benefits and services related to high-risk pregnancies.
