Becoming a new parent is an exciting and transformative experience. As you adjust to life with your new bundle of joy, one of the most important tasks is ensuring your child has proper health coverage. Navigating the world of health insurance can be overwhelming, especially for new parents. To make the process smoother, we’ve broken down the steps you need to take to shop for health insurance for you and your child.
Act Quickly During the Special Enrollment Period
After welcoming your new child, you’ll need to act fast. The Affordable Care Act (ACA) gives new parents a special enrollment period that lasts only 60 days. This means you must update or change your health insurance plan within two months of your baby’s arrival to ensure coverage begins immediately. If you miss this window, you’ll have to wait for the next open enrollment period.
Evaluate Your Current Plan
If you already have health insurance, the first step is to evaluate whether it makes sense to add your child to your current plan or switch to a new one. Take a close look at the coverage and costs associated with both your plan and your partner’s plan (if applicable). Some things to consider:
- Premiums: How will adding your child impact your monthly premium?
- Subsidies: If you’re on a marketplace plan and receiving subsidies, check how your eligibility might change.
- Coverage and Deductibles: Babies need frequent doctor visits in their first year, so check what’s covered and the associated costs for these visits.
- Pediatrician Availability: If you have a specific pediatrician in mind, verify they’re in-network for your plan.
- Special Needs: Does your baby have any medical needs that need to be covered, such as specific medications or treatments?
If you’re unsure about any details, contact your insurance provider directly to clarify.
Adding Your Child to Your Existing Plan
If you decide to keep your current health insurance, the next step is to contact your insurance provider to add your baby. You’ll likely need to provide your child’s birth certificate or adoption papers, and if your plan is employer-sponsored, you may have to go through your HR department to complete the update.
Choosing a New Plan: What to Look For
If you choose to shop for a new health insurance plan, make sure you take the time to choose wisely. Since you won’t be able to switch plans again until the next open enrollment period, you want to pick a plan that offers the best coverage for both you and your child. Here are some tips for selecting the right health insurance plan:
Don’t Just Focus on Premiums
While the lowest premium might seem tempting, it’s important to think beyond just the monthly cost. Babies need frequent healthcare, with some visits even required six times during their first year. In addition to premiums, look at the deductibles, copays, and coinsurance for doctor visits, as well as the costs for treatments and medications. Sometimes a plan with a slightly higher premium can save you more money in the long run with lower out-of-pocket costs.
Review the Plan’s Network
Before committing to a plan, check its network of providers. If you have specific doctors, pharmacies, or hospitals you prefer (for yourself or your child), ensure they are in-network. If you’re unsure, you can also contact the provider to verify network details since insurance directories can sometimes be outdated. If you don’t have a specific provider in mind, consider the size of the plan’s network. A smaller network could make it harder to find in-network specialists or doctors, so it’s important to make sure the plan’s network fits your needs.
Understand What’s Covered
All ACA-compliant plans must cover essential health benefits, including wellness visits, immunizations, and screenings for children. However, it’s important to check for other specific services or treatments that may be important to your family. Review the Summary of Benefits & Coverage (SBC) for details on what’s included and ask your insurance provider for cost estimates on any treatments or tests you anticipate needing.
Make Use of Your Benefits
Once you and your baby are covered, it’s crucial to take full advantage of the health insurance benefits available to you. Schedule wellness visits with your pediatrician, get all recommended immunizations, and take advantage of any screenings your plan covers. Early healthcare can help your baby avoid serious illnesses and allow you to catch any health issues early on.
Ensuring your baby gets the right healthcare in their first year is an important step in setting them up for a healthy life. With the right health insurance plan, you can focus on what matters most—enjoying this exciting time with your new little one.
