Health Insurance Options for Pregnant Women

Federal law requires plans to cover maternity-related care, but states have the flexibility to determine which services are covered.

With so many coverage options and plans to choose from, which is right for you and your new bundle of joy?

Women, particularly pregnant women, have more heath insurance options than ever before thanks to health care reform, with many gaining access to affordable coverage for the first time.

'The fact that the Affordable Care Act requires qualified health plans to cover maternity care and offers financial assistance to reduce out-of-pocket costs is a game changer for many women,' says Lauren Birchfield Kennedy, director of health policy at the National Partnership for Women and Families, a nonprofit in the District of Columbia. 'It's probably the greatest advance in women's health in a generation.'

Karen Davenport, director of health policy at the National Women's Law Center, says the federal law has given 'women lots more flexibility in terms of their work lives and health insurance decisions because they know they can purchase coverage on their own and have all [maternity-related] services covered.'

Here's a look at coverage options for pregnant women and those who may be considering pregnancy.

Guaranteed coverage. Maternity and newborn care are among the essential health benefits that all marketplace and job-based health insurance plans must provide by law. Health plans also must cover prenatal care visits without any cost-sharing.

Before the law, a 'significant percentage of individual plans did not cover maternity health services at all, or if they did it was usually a pretty thin benefit that often left women having to cover services out of their pocket,' Kennedy says.

In some states, women couldn't get insurance because pregnancy was considered a pre-existing condition. 'Women now have the peace of mind of knowing they cannot be denied coverage because of a pre-existing condition,' she says.

Discounted coverage. If you're uninsured, you may qualify to receive discounted coverage if you buy a plan in the state and federally operated marketplaces (like HealthCare.gov) created by the law. These marketplaces offer tax credits for premiums and subsidies for out-of-pocket expenses, depending on your income and household size.

Open enrollment in the government marketplaces runs until Feb. 15, 2015. But if you miss this deadline, you'll need to wait until next year to get coverage. 'We encourage anyone who is pregnant or who thinks they may become pregnant to visit the marketplace now to make sure they have coverage for the duration of their pregnancy,' Kennedy says.

Compare plans. Carefully compare the benefits, cost-sharing structure and health care provider networks among plans, advises Davenport. Although the federal law requires plans to cover maternity-related care, states have the flexibility to determine what exact services are covered. Provider networks and out-of-pocket costs vary from plan to plan, too.

Update your information. If you already have coverage from a state and federal marketplace, you may qualify to receive a larger tax credit or switch to a different plan that works better for your expanding family. With subsidies based on income and household size, the addition of a baby or the loss of income due to a maternity leave could lead to bigger coverage savings. Let the marketplace know about these life changes as soon as possible.

Special enrollment period. You can buy or change an insurance policy during a special enrollment period after a qualifying life event, such as having or adopting a child. Typically, you have 60 days to enroll from the date of the child's birth. Special enrollment periods apply to marketplace and job-based plans. Being pregnant does not trigger eligibility for a special enrollment, though. 'You qualify for a special enrollment once the baby is born,' Davenport says.

Medicaid and CHIP. Pregnant women with lower and moderate incomes may qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program, depending on where they live. Women can enroll in Medicaid or CHIP at any time.

By law, states must offer Medicaid coverage to pregnant women with incomes at or below 133 percent of the federal poverty level ($15,560 for an individual or $31,800 for a family of four), although some states cover pregnant women with incomes of 185 percent of poverty. Medicaid also must cover pregnancy-related services without cost sharing.

States also have the option to provide prenatal, delivery and 60-day postpartum care to lower-income pregnant women through CHIP.

Breast-feeding resources. All marketplace and employer-based plans must cover breast-feeding services and supplies without any cost-sharing expenses to women. This includes coverage for consultations with a lactation expert, breast pumps and more.

This benefit is 'new for breast-feeding moms and insurance companies, so there are definitely some coverage kinks that over time will get worked out,' Davenport says. The National Women's Law Center has a toolkit on its website to help breast-feeding moms understand their rights and appeal decisions if a plan denies coverage.