Pregnancy/Maternity Healthcare Guide

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Pregnancy/Maternity Healthcare Guide

The wonders of motherhood tend to combine with the worries of parenting. Once you become pregnant, the health of your child becomes your primary concern. By default, you must also focus on your health to help ensure that both you and the baby are fine before and after you give birth. Getting good maternity health care in the United States is mainly dependent on your insurance or government benefits. To protect yourself and your child, you need to understand items covered under most insurance policies as well as your options before and after the baby is born. Below are a few key insurance facts that apply to your pregnancy.

Insurance Rights

The passage of the Affordable Care Act made it easier for pregnant women to receive the health care and health insurance that they need. Before the ACA, insurance companies could refuse to cover pregnant women as pregnancy fell under a preexisting condition. Now, these companies cannot deny your application or charge you more due to your pregnancy. If you do not have insurance when you discover you are pregnant, you can sign up for a policy as long as it's during the plan's open enrollment period, typically from October through December. Otherwise, you can get insurance only if you experience a significant life event, which, ironically, pregnancy is not. Life events include:

  • Loss of health coverage. This can be due to losing a job, losing eligibility for Medicaid or turning 26 and losing coverage through your parents' policy.

  • Household changes. These include getting married, getting divorced, having a baby, adopting a child, or experiencing a death in the family.

  • Residence changes. This can include moving to a different ZIP code or county, changing colleges, moving to transitional housing, etc.

  • Other qualifying events include becoming a US citizen, income changes, and leaving prison.

 Note that you have more insurance options after you give birth. You do not need an open enrollment period to get insurance once your child is born. If your income is low enough, you can qualify for Medicaid or CHIPS, which allows you to enroll all year long.

Key Maternity Coverages

The United States now requires all insurance policies to provide maternity care and childbirth services, exempting only a few individual plans that were grandfathered in after the ACA passed. Under the law, these services are considered essential health benefits. Maternity benefits include the following:

  • Prenatal and postnatal outpatient services such as doctor visits, labs, medications and screenings

  • Hospital stays and associated physician bills

  • Newborn baby services

  • Lactation help and breast pump rentals.

While these benefits are covered under government qualified plans, they are certainly not free. You will likely pay premiums, deductibles, and co-pays. The cost of your pregnancy and delivery will vary according to the type of coverage you have, where you live, etc. However, you may qualify for a government subsidy through healthcare.gov. When you enroll on the site, you provide income information that determines what amount of monthly subsidy you receive. Some people qualify for $1000 or more each month, which may reduce their premiums to the $100 - $200 range or less. Although their open enrollment period has closed for 2019, you may still qualify for a special enrollment period depending on your circumstances.

Insurance Status Updates

Once the baby is born, you need to immediately have them added to your health insurance policy or your partner's policy. In general, the deadline for adding a newborn is 30 days after the birth, which then makes the coverage retroactive to their birth date. Failure to take care of this task can lead to a ton of red tape and possible astronomical medical bills. Your insurance company will not automatically add your baby, even though they receive your hospital maternity bills. Some remind you to add your baby, while others do not. Fortunately, many companies let you make this addition via phone call or a visit to their website. Remember, if you have no insurance, you can acquire a policy once the baby is born since that qualifies as a life event. Your little one allows you to purchase immediate coverage instead of waiting for the next open enrollment date. Maternity expenses can still be pretty steep, but most mothers are eligible for some insurance help. Low-income families or single mothers can get help from Medicaid or CHIP (Children's Health Insurance Program). You may also qualify for assistance from the ACA or healthcare marketplace. Even if you have to struggle through pregnancy without insurance, you will be able to get coverage for you and your child once the little one is born. Health care for mothers and infants is still not perfect in the United States, but you do have some legal protections. Maternity services are considered essential benefits, and almost all insurance plans must cover them. Major employers generally provide excellent coverage for their employees and their partners in this area. And some affordable plans with reasonable deductibles do exist and assist pregnant women. So take advantage of every benefit offered to you during this special and vulnerable time.

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