There are about 6 million pregnancies per year in the United States and the costs associated with pre-natal, maternity care, and delivery can be overwhelming for some women. Medicaid and certain Community Health Centers provide free or low-cost coverage to qualifying pregnant women to help pay for pregnancy-related healthcare.
Some pregnant women may be eligible for the Children's Health Insurance Program (CHIP), which provides healthcare to children and families that do not qualify for Medicaid, but still cannot afford to purchase health insurance. CHIP’s coverage for expectant mothers generally includes lab testing, labor/delivery, and at least 60 days of care after delivery.
The Affordable Care Act and Maternity Coverage
Currently pregnancy is considered to be a pre-existing condition and women who apply for health plans compliant with the Affordable Care Act cannot be denied coverage or be charged a higher premium if they become pregnant before applying for healthcare. The Affordable Healthcare Act (ACA), sometimes referred to as Obamacare, mandated that health insurance companies must sell coverage to everyone at the same premium regardless of pre-existing medical conditions starting January 1, 2014. However, the Affordable Care Act does not apply to Term Health Insurance plans. Consequently, term health plans can choose not to provide maternity coverage or cover a pre-existing pregnancy.
Other ACA mandates specific to pregnancy include the following:
- Job-based health plans and new individual plans cannot deny coverage to anyone due to a pre-existing condition including pregnancy. Furthermore, these health plans must provide coverage to children even if the child was born with health problems
- New health plans must provide ACA-covered preventative services without cost-sharing (e.g. copayments, co-insurance, and deductibles)
- Health Insurance subsidies in the form of tax credits will be provided to qualifying individuals and families. Recipients will qualify based on annual income and family size
Current expanded essential health benefits included in the ACA include screening for gestational diabetes and breastfeeding supplies. These benefits went into effect in August 2012. It is estimated that the expansion of the Affordable Healthcare Act will provide maternity care to about 8.7 million women who currently are not covered. At HealthPocket, you can use the Plan Comparison Tool to find the right individual health insurance plan in order to minimize your out of pocket healthcare costs.