Health insurance (also called health coverage or a health plan) helps you pay for health care. Health insurance is really important to you, especially if you’re pregnant.
what health care services are covered for a pregnant woman?
After the Affordable Care Act (also called ACA) was passed, the health care law required all insurance plans in the Health Insurance Marketplace (also called Marketplace) or Medicaid to cover many services for pregnant women . the marketplace is an online resource that helps you find and compare health plans in your state. These insurance plans cover services for pregnant women that include:
- all prenatal care visits with no copay. Prenatal care is the medical care you receive during pregnancy. No copay means you don’t have to pay your health care provider each time you get a prenatal checkup. You can see your prenatal care provider without a referral from a primary care provider (who gives you basic medical care). therefore, you do not have to see your primary care provider first to get approval to see a prenatal care provider, such as an OB/GYN (also called an OB/GYN), nurse midwife, or nurse practitioner.
- labor and birth services
- Help to breastfeed with no copay. this includes visits with a lactation consultant, breastfeeding equipment, and breast pumps. A lactation consultant is someone with special training to help women breastfeed.
- birth control.
- regular health check-ups
- checkups when you are sick
- hospital care
- emergency services
- drop your health insurance if you get sick
- You are charged more for health care services because you are a woman
- charge you more for health care services if you have had a medical condition in the past
- Set an annual or lifetime cap (limit) on coverage. This means that an insurance company cannot stop covering your medical expenses once they reach a certain amount of money. this also applies to your partner.
- have you pay unlimited out-of-pocket costs. insurance plans have to set yearly limits on what you pay for your own health care. once you reach the limit, the company has to pay your expenses for the rest of the year.
Insurance plans in the marketplace and Medicaid must cover these services for everyone, including pregnant women:
The health care law says a plan cannot:
if you are pregnant, how do you know which health insurance to choose?
When choosing your health plan, check the plan summary. each plan has a summary that includes the expected costs of pregnancy care. Each plan uses the same summary form, so it’s easy to compare costs and services. you can find plan summaries on the health insurance marketplace. this is an online resource that helps you find and compare health plans in your state. If you are working, you may also have health insurance through your employer. Check with your employer for a summary of the plan and benefits.
Is it okay to be pregnant when you join a health plan?
yes. You can be pregnant when you take out health insurance. if this happens, the pregnancy is called a pre-existing condition. this means you had the condition (were pregnant) before you signed up for health insurance. Under the post-ACA health care law, insurance companies cannot deny you coverage or charge you more money to treat pre-existing conditions.
what if you need help paying for health insurance?
In most states, many pregnant women can get Medicaid coverage. Medicaid is a government program that provides free or low-cost health insurance to low-income people. In some states, pregnant women who earn too much for Medicaid can get health coverage through the Children’s Health Insurance Program (also called CHIP). chip is a government program that provides health insurance to some children and pregnant women in families who earn too much for health care but cannot 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 to help pay for insurance through your state’s Marketplace. You can get information about health plans and costs for pregnant women at your state’s marketplace. be sure to say you are pregnant on the marketplace request for pregnancy information.
last revised: September 2020
