Childbirth in the U.S. is very expensive. According to data, it costs an average of $18,865 for full maternity care, including pregnancy, delivery, and postpartum care. For most households, footing this bill can be financially challenging. That’s why you need to consider maternity coverage services.
Maternity coverage softens the financial impact of maternity, reducing your out-of-pocket costs for childbirth and other prenatal and postnatal care. But there are many questions surrounding this type of insurance that most expectant parents need answering.
Here’s what you need to know about maternity coverage and the available options.
Is Childbirth Part of Health Insurance?
In 2014, health insurance for labor, pregnancy, delivery, and newborn care was made mandatory under the Affordable Care Act (ACA). The Affordable Care Act recognizes pregnancy and maternity care as one of the ten essential health benefits that health insurance plans must cover for families, individuals, and small groups.
Therefore, all major ACA/medical health insurance plans include maternity coverage, which includes pregnancy and childbirth.
Even if you can’t afford health insurance or don’t have it for any other reason, you can still access free or discounted maternity services for expectant parents in your area. Some of these options include hospital indemnity policies.
However, these alternative options don’t provide as many benefits as a medical health insurance plan.
What Is Covered Under Maternity Coverage?
Most health insurance plans cover the following maternity services:
- Outpatient services such as prenatal and postnatal doctor visits, lab studies, gestational diabetes screening, and medications
- Newborn baby care
- Inpatient services such as physician fees and hospitalization
- Lactation counseling and devices
The exact coverage will differ based on the insurance provider, their plans, and the benefits of each plan. Your out-of-pocket costs will also depend on factors such as deductibles, the metallic tier of coverage, preferred provider, and copayments.
The Most Common Options for Maternity Insurance
There are several ways you can get health insurance, including maternity coverage. The following are the most common options:
Your employer may offer group health plans as part of employment benefits. This may include partial or complete payment of your monthly premiums.
Eligibility for employer-sponsored health insurance typically varies across companies. Also, the coverage levels will still vary despite maternity coverage being mandatory for all ACA-compliant group health plans.
Most individuals on Medicare are aged 65 and above. Therefore, maternity coverage is unnecessary for them. However, younger adults with qualifying disabilities can also access Medicare and take advantage of its maternity coverage, including childbirth, pregnancy, and postnatal care.
Medicare doesn’t cover your baby after birth.
Health Insurance Market Plans
You can shop for individual health insurance plans at the Health Insurance Marketplace. All plans in the marketplace are ACA-compliant, meaning you’ll get maternity coverage for you and your baby before and after birth.
Most plans in the Health Insurance Marketplace also offer subsidies to qualified individuals to reduce monthly premiums. All plans purchased through the marketplace must include breastfeeding and birth control coverage.
Qualifying expectant parents can get maternity coverage from Medicaid. Enrollment is typically open anytime, and coverage starts immediately. Also, your newborn is automatically put under Medicaid coverage after birth.
Medicaid is available through the Health Insurance Marketplace or state Medicaid agency.
Children’s Health Insurance Plan (CHIP)
You can enroll for CHIP coverage anytime and start the plan immediately. CHIP is available directly through the state agency or Health Insurance Marketplace. It is income-based, meaning not everyone can qualify.
The Benefits You Should Consider When Looking at Maternity Coverage Plans
The following are important things you should consider about your current or future health insurance plan with maternity coverage:
- Possibility of getting a referral to see a specialist or OBGYN from your primary care doctor
- Covered costs of labor and delivery
- Covered costs of prenatal testing, including amniocentesis, ultrasounds, and genetic testing
- Affordable coinsurance, copay, and deductible amounts
- Preauthorization to receive prenatal care
- Coverage for non-traditional deliveries, including home births and midwives, if you plan to have a non-traditional childbirth
- Coverage for private rooms if you don’t want a shared room for hospital delivery
Consult an Expert
Maternity should not be an expensive experience for you, your partner, and your family. Contact the professionals at Goldstein Healthcare today and learn which plan will suit you.