How to Choose a Health Insurance Plan When Pregnant

Pregnancy is one of the most exciting times in life, but it also comes with significant healthcare costs. From prenatal visits and lab work to delivery and postpartum care, the expenses can add up quickly. Choosing the right health insurance plan before or during pregnancy can save you thousands of dollars and ensure you receive the care you need.

Maternity Coverage Under the ACA

Thanks to the Affordable Care Act, all plans sold on the ACA Marketplace are required to cover maternity and newborn care as an essential health benefit. This includes prenatal visits, labor and delivery, and postpartum care. However, the amount you pay out of pocket varies significantly depending on the plan you choose. Short-term health plans and plans that are not ACA-compliant may not cover maternity care at all, so it is critical to verify your coverage before enrolling.

Key Factors to Compare When Choosing a Plan

1. Deductible: A lower deductible means you start receiving covered benefits sooner, which matters when you know you will have significant medical expenses during pregnancy and delivery.
2. Out-of-pocket maximum: Since pregnancy often involves hitting your out-of-pocket max, choosing a plan with a lower cap can save you substantial money overall.
3. Provider network: Make sure your preferred OB-GYN, midwife, and hospital are in-network. Out-of-network delivery charges can be extremely expensive.
4. Copays and coinsurance: Compare what you will owe for each prenatal visit, ultrasound, and lab test. Some plans cover preventive prenatal services at no cost.
5. Newborn coverage: Your baby will need to be added to your plan within 30 days of birth. Understand how adding a dependent affects your premium.

Timing Your Enrollment

If you are planning a pregnancy, the best time to enroll in or switch plans is during Open Enrollment. However, if you become pregnant outside of Open Enrollment, certain life events — such as losing other coverage, getting married, or moving — may qualify you for a Special Enrollment Period. Having a baby itself also triggers a Special Enrollment Period, allowing you to add your newborn and adjust your coverage.

Navigating maternity coverage options can be overwhelming, especially when you are preparing for a new addition to your family. Our advisors at Resilience Health Advisors specialize in helping expecting parents find the right coverage at the right price. Reach out to us today to get personalized guidance on choosing the best plan for your growing family.