Health insurance (also called health coverage or a health plan) helps you pay for medical care. Health insurance is really important for you, especially if you’re pregnant.
What health care services are covered for a pregnant woman?
After the Affordable Care Act (also called ACA) passed, health care law requires all insurance plans on the Health Insurance Marketplace (also called Marketplace) or Medicaid to cover many services for pregnant women. The Marketplace is an online resource that helps youfind and compare health plansin your state.These insurance plans cover services for pregnant women including:
- Allprenatal care visitswith noco-pay. Prenatal care is medical care you get during pregnancy. No co-pay means you don’t have to pay your health care provider each time you go for a prenatal checkup. You can see your prenatal care provider without a referral from a primary care provider (who gives you basic health care). So you don’t have to see your primary care provider first to get an OK to see a prenatal care provider, like an obstetrician/gynecologist (also called OB/GYN), nurse-midwife or nurse practitioner.
- Labor and birth services
- Breastfeeding help with no co-pay. This includes visits with a lactation consultant, breastfeeding equipment and breast pumps. A lactation consultant is someone with special training in helping women breastfeed.
- Birth Control.
Insurance plans in the Marketplace and Medicaid have to cover these services for everyone, including pregnant women:
- Regular health checkups
- Checkups when you’re sick
- Hospital care
- Emergency services
Health care law says that a plan can’t:
- Drop your health insurance if you get sick
- Charge you more for health care services because you’re a woman
- Charge you more for health care services if you’ve had a medical condition in the past
- Set a lifetime or annual cap (limit) on coverage. This means that an insurance company can’t stop covering your medical expenses once they reach a certain amount of money. This goes for your partner, too.
- Make you pay unlimited costsout-of-pocket. Insurance plans have to set yearly limits on what you pay on your own for health care. Once you reach the limit, the company has to pay your expenses through the rest of the year.
If you’re pregnant, how do you know what health insurance to choose?
When you’rechoosing your health plan, look at the plan summary. Each plan has a summary that includes the expected costs of pregnancy care. Every plan uses the same summary form, so it’s easy to compare costs and services. You can find plan summaries in the Health Insurance Marketplace. This is an online resource that helps youfind and compare health plans in your state. If you are working, you may also have health insurance through your employer.Check with your employer to learn about the plan summary and benefits.
Is it OK to be pregnant when you sign up for a health plan?
Yes. You can be pregnant when you sign up for health insurance. If this happens, pregnancy is called a pre-existing condition. This means you had the condition (you were pregnant) before you sign up for health insurance.Under health care law after the ACA, insurance companies can’t deny you coverage or charge you more money to care for pre-existing conditions.
What if you need help paying for health insurance?
In most states, many pregnant women can getMedicaidcoverage. Medicaid is a government program that provides free or low-cost health insurance to people with low income. In some states, pregnant women who earn too much for Medicaid can get health coverage through theChildren’s Health Insurance Program (also called CHIP). CHIP is a government program that provides health insurance to some children and pregnant women in families that earn too much to get Medicaid but can’t afford private insurance.You can apply for Medicaid and CHIP at any time.
Even if you can’t get Medicaid, you may be able to get tax credits that help pay for insurance through your state’s Marketplace. You can get information abouthealth plans and costs for pregnant womenin your state’s Marketplace. Be sure to say you’re pregnant on the Marketplace application so you get pregnancy information.
Last Reviewed: September 2020
