Pregnancy is an exciting time, but it also comes with its own set of challenges. From planning the birth to choosing the best healthcare coverage, there’s a lot to think about. One of the biggest considerations for expectant parents is health insurance. With the cost of pregnancy and childbirth in the U.S. averaging nearly $19,000, it’s essential to make sure you’re covered. Fortunately, health plans that comply with the Affordable Care Act (ACA) provide maternity coverage, which includes pregnancy, childbirth, and newborn care.
Here’s what you need to know when choosing a health plan during pregnancy and what to consider for the future.
Understanding the Health Insurance Enrollment Timeline
The good news is that ACA-compliant plans must cover maternity services, regardless of whether you’re already pregnant when you sign up. However, there’s a catch—pregnancy alone doesn’t qualify for a special enrollment period. You can sign up for a plan during the open enrollment period (from November 1 to January 16) or during a special enrollment period triggered by a life event, like the birth of a child. It’s best to act before your baby arrives to avoid paying out-of-pocket for pregnancy and labor expenses.
What to Consider When Shopping for Health Insurance During Pregnancy
Choosing the right health plan during pregnancy can seem overwhelming, but these tips will help guide your decision.
1. Think About Your Birth Plan
While pregnancy and childbirth can be unpredictable, considering what you want your experience to look like can help you plan for the best possible care. Here are the main stages to think about:
- Pre-pregnancy: If you’re planning to get pregnant, consider whether fertility treatments like IVF might be part of your journey. Many plans don’t cover fertility treatments, which can be expensive. Finding a plan that covers this service could save you thousands.
- During pregnancy: Regular check-ups, prenatal vitamins, ultrasounds, and birthing classes are part of a typical pregnancy plan. Make sure to choose an insurance plan that covers these services and uses in-network providers to avoid additional costs.
- Labor: If you’re considering a birth center, doula, midwife, or at-home birth, you’ll likely face lower costs than in a hospital, but insurance may not cover these services. Within a hospital, vaginal births are typically less expensive than c-sections, though some medical conditions may require the latter.
- Postpartum care: After giving birth, your baby will need immediate healthcare, but you’ll also need postpartum care to recover and possibly address any mood disorders. If you plan to breastfeed, check if your plan covers lactation consultants.
2. Make a List of Must-Haves
It’s important to figure out what aspects of your pregnancy and birth care are non-negotiable. Some key things to consider:
- A specific ob-gyn or healthcare providers you trust
- A particular hospital or birthing center you want to deliver at
- Specific care or procedures you anticipate needing
- Any ongoing prescriptions, whether related to pregnancy or not
Knowing your must-haves will help you narrow down your health plan options and ensure you’re getting the coverage you need.
3. Check for In-Network Providers
Once you have your list of must-haves, start comparing available health plans. Whether you’re using an employer-sponsored plan or browsing options on the marketplace, ensure your doctors and hospitals are in-network. Some online tools let you search for specific providers, but calling to double-check with the doctor’s office is always a good idea, as insurance directories are often outdated.
4. Choose a Low Deductible Over a Low Premium
While it might be tempting to go for a plan with the lowest premium, remember that pregnancy and childbirth can be expensive. A plan with a lower premium could mean a high deductible, meaning you’ll pay more out-of-pocket before your insurance begins covering your costs. Instead, prioritize a plan with a lower deductible to reduce your financial burden during pregnancy and birth.
Also, keep in mind that copays and coinsurance can add up. Copays are the amount you pay upfront for medical visits, while coinsurance is the percentage of the bill you pay after your insurance kicks in. Be sure to review these details for each plan.
5. Review the SBC (Summary of Benefits and Coverage)
Every ACA-compliant plan includes an SBC, which outlines the coverage and costs for various services. The SBC will include examples of common events, such as pregnancy, which can give you an idea of what your costs may be. Although it won’t provide exact figures for pregnancy costs, it can help you compare plans and make more informed decisions.
6. Verify In-Network Status for Providers
Health insurance directories aren’t always up-to-date, so it’s wise to call your ob-gyn’s office and other healthcare providers directly to confirm they’re in-network. This ensures you won’t face any unexpected costs during your pregnancy.
Final Thoughts
Selecting the right health insurance plan is an important step in preparing for pregnancy. While it won’t make the experience easy, the right plan can ease some of the financial burdens. Pregnancy and childbirth can be expensive, but with the right coverage, you’ll be able to focus more on your growing family and less on the stress of unexpected medical bills. Taking the time now to find the best health plan will be a decision you’ll be grateful for later.
