Alyssa Lane
Pregnancy and childbirth are costly, and health insurance is a vital safety net for expectant families. The Affordable Care Act (ACA) has made it easier for pregnant women to get insurance to help pay for medical care. All qualified health plans must meet the ACA requirement for minimum essential coverage, and insurance plans in the Marketplace and Medicaid must cover everyone, including pregnant women. Medicaid and CHIP provide free or low-cost health coverage to millions of Americans, including pregnant women, and you can apply for them at any time. If you have no insurance and cannot sign up during the enrollment period, you may qualify for Medicaid now that you're pregnant, and you can enroll in Medicaid year-round. CHIP, or the Children's Health Insurance Program, covers prenatal care, childbirth, and baby care during pregnancy and for 60 days after delivery. Short-term disability insurance is another option to help offset the cost of pregnancy and birth by covering the time you're out of work.
| Characteristics | Values |
|---|---|
| Cost of childbirth | The average cost for a vaginal delivery was $14,768 ($2,655 out-of-pocket) and a cesarean section was $26,280 ($3,214 out-of-pocket) from 2018-2020. |
| Insurance coverage | The Affordable Care Act requires all plans on the Health Insurance Marketplace or Medicaid to cover prenatal care, childbirth, and newborn care. |
| Medicaid | A government program that provides free or low-cost health insurance to people with low incomes. |
| CHIP | The Children's Health Insurance Program provides health insurance to some children and pregnant women who earn too much for Medicaid but can't afford private insurance. |
| Short-term disability insurance | This type of coverage helps cover the time you're out of work while pregnant, as well as during and post-delivery. |
| Special enrollment | Having a baby qualifies you for a special enrollment period, allowing you to enroll in a health plan even if it's outside the Open Enrollment Period. |
| Marketplace coverage | If you have Marketplace coverage and report your pregnancy, you may be eligible for free or low-cost coverage through Medicaid or CHIP. |
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What You'll Learn
Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including low-income people, families, children, pregnant women, the elderly, and people with disabilities.
Eligibility for Medicaid and CHIP varies by state, but typically, those with an annual income of 133% or below the Federal Poverty Line (FPL) qualify for Medicaid as they are considered "categorically needy". However, due to expansions of Medicaid, women who are pregnant are more likely to qualify for coverage, even if they were previously denied based on income. They may now be considered "medically needy". Additionally, some states have expanded their Medicaid programs to cover all people with household incomes below a certain level. It is recommended that even if you don't qualify for Medicaid based on income, you should still apply, as you might qualify for your state's program, especially if you are pregnant.
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Affordable Care Act
The Affordable Care Act (ACA) has made it easier for pregnant women to get insurance and pay for medical care. Before the ACA, insurance companies could deny coverage if pregnancy was considered a pre-existing condition, and many health plans did not offer maternity coverage. Now, health plans cannot deny coverage or charge more due to pregnancy.
Under the ACA, all individual and small employer insurance plans, including those obtained through the Marketplace, must cover maternity and newborn care. This includes prenatal visits and screenings, folic acid supplements, tobacco cessation counselling, and breastfeeding services, such as pumps and lactation consultations. These services are considered preventive and are provided without cost-sharing. However, some health plans are not required to cover all pregnancy-related services, and cost-sharing may apply to certain maternity services.
Grandfathered health plans, which existed before the ACA and have not significantly changed, are not mandated to offer maternity and newborn care. Additionally, short-term health plans are generally exempt from covering maternity care. It is important to review the specific benefits covered by your health plan to understand what pregnancy-related services are included.
The ACA also provides support for new mothers, such as requiring employers to give nursing mothers reasonable break times to pump breast milk. Furthermore, new mothers and their families may qualify for home visiting services that offer assistance with breastfeeding, postpartum depression, smoking cessation, and more. These services can begin during pregnancy and continue through the child's first three years.
Medicaid, a government program offering free or low-cost health insurance to low-income individuals, also provides coverage for pregnant women. Most states have expanded Medicaid eligibility to include pregnant women with incomes up to or over 185% of the federal poverty level. Coverage under Medicaid continues through pregnancy, labour, delivery, and the first 60 days after birth. Additionally, if a woman has Medicaid when giving birth, her newborn is automatically enrolled in Medicaid coverage for at least one year.
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Short-term disability insurance
It is important to note that individual short-term disability policies may require medical underwriting, and pre-existing conditions are usually excluded. Therefore, if you apply for short-term disability insurance while pregnant, it will likely be considered a pre-existing condition, and any claims relating to pregnancy may be excluded. Employer-provided short-term disability insurance, on the other hand, typically covers pregnancy and maternity benefits and does not require medical underwriting.
To ensure you have the necessary coverage, it is recommended to apply for short-term disability insurance as soon as you know you want to have children, even if you are not yet pregnant. Additionally, carefully review the requirements and benefits of your specific policy to understand what is covered and how to submit claims.
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Tax credits
In the US, the cost of pregnancy and childbirth can be very high. Without insurance, the average cost for a vaginal delivery is $14,768, with $2,655 paid out-of-pocket, and a cesarean section costs $26,280, with $3,214 paid out-of-pocket. Therefore, insurance is a vital safety net for expectant families.
One option for pregnant women is Medicaid, which provides free or low-cost health coverage to millions of Americans, including some low-income people, families, children, and pregnant women. Pregnant women are more likely to qualify for Medicaid coverage, even if they were previously denied based on income. However, eligibility varies by state. 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.
Another option is the Children's Health Insurance Program (CHIP), which also provides free or low-cost health coverage. If you report your pregnancy, you may be eligible for free or low-cost coverage through CHIP.
Short-term disability insurance is another option to help cover the time you're out of work while pregnant, as well as during and post-delivery. This type of coverage can provide much-needed income during and after pregnancy, especially if you expect a complicated delivery or multiples.
In terms of tax credits, the IRS offers unique tax benefits to parents, including the Child Tax Credit. For tax years 2024 and 2025, the Child Tax Credit is $2,000 per child for qualifying children through age 16. A portion of this credit can be refundable, meaning eligible families can receive it as a refund, even if they owe no federal income tax. If you're not married, having a child may allow you to file as a head of household, resulting in a bigger standard deduction and more advantageous tax brackets. Additionally, if you pay for childcare to work and earn income, you may be eligible for a credit worth up to $1,050 per child.
Furthermore, certain pregnancy-related expenses may be tax-deductible. If you incur significant medical expenses related to your pregnancy, you may be able to deduct a portion of the cost on your income taxes. Diagnostic tests and procedures during the first trimester, as well as tests to detect birth defects, are deductible. It is important to gather all receipts for doctor visits, hospital stays, medication purchases, and health insurance premiums when preparing your tax return.
In Missouri, there is also a Pregnancy Resource Center Tax Credit program. Donors can contribute to qualified pregnancy resource centers and claim up to a $50,000 credit per tax year.
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Employer-provided insurance
If you are pregnant, you may be offered health insurance through your employer. The Affordable Care Act (ACA) has made it easier for pregnant women to obtain insurance to cover the medical care they need. All qualified health plans must meet the ACA requirement for "minimum essential coverage". This means that, regardless of whether you receive health insurance through your employer or purchase it yourself, you should be covered.
However, small employers (those with fewer than 50 employees) are not required to provide healthcare coverage. If they do, they must include maternity care. Group plans are not required to provide complete maternity coverage for dependent children, although adult children can remain on their parents' healthcare plans up to the age of 26.
If you are pregnant and already have employer-provided insurance, you should check with your provider to see what is covered. Some insurance plans may cover pregnancy care and childbirth, as well as newborn care. This may include prenatal care visits with no co-pay, meaning you do not have to pay your healthcare provider each time you go for a prenatal checkup. You may also be able to see your prenatal care provider without a referral from a primary care provider.
If you are considering getting pregnant, it is worth checking with your insurance provider to see what is covered. You may also want to look into short-term disability insurance, which can cover the time you are out of work while pregnant, as well as during and post-delivery. This type of coverage can provide much-needed income during and after pregnancy, especially if you expect a complicated delivery or multiple births.
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Frequently asked questions
The first step is to check your income level to see if you qualify for Medicaid or CHIP. You can apply for these at any time during the year.
You can shop for private health insurance outside of the marketplace through insurance companies, agents, brokers, and online health insurance sellers.
If you have Marketplace coverage, you can report your pregnancy, and you will be forwarded to your state agency that handles Medicaid or CHIP.
You can look into short-term disability insurance, which covers the time you're out of work while pregnant and during and post-delivery. You can also look into giving birth in a birth centre instead of a hospital, which can be cheaper.
