Maternity Coverage Explained

Pregnancy is a very special time in a woman’s life, but it’s also a stressful one. The idea of becoming a mom and all the joys that come along with bringing a little one into the world can be overshadowed by financial worry. Babies are expensive, and the expenses begin right after a soon-to-be mom finds out that she’s expecting.

maternity coverageProper prenatal care is vital for expectant moms and their developing babies. It ensures that everything is going smoothly and can catch problems that could become serious or potentially life-threatening for both mom and baby, such as gestational diabetes and preeclampsia; among other things. Medical care is also vital for birth, as well as postnatal care.

Despite how crucial medical care is for expectant moms and their babies, in the United States, women haven’t always had an easy time getting the health insurance they need. Prior to 2014, if a pregnant woman didn’t have insurance and attempted to get coverage, the chances of purchasing an individual policy were slim to none. Furthermore, if the woman had health insurance through her work, it didn’t necessarily mean that her pre- and postnatal medical needs would be covered, as employers weren’t required offer coverage for maternity care. Moreover, if a woman had coverage or was able to purchase a policy, she would be charged an exorbitantly higher rate.

Fortunately, that all changed in 2014, thanks to the Affordable Care Act (ACA or Obamacare). With the passage of the ACA, health insurance companies were no longer allowed to deny coverage or charge higher premiums for maternity care; for both individual and employer-sponsored policies. That’s because pregnancy is considered a pre-existing condition, and Obamacare prevents insurance companies from denying or increase premiums for any pre-existing condition – including pregnancy.

Thanks to the ACA, some of the stress that expectant women experience can be alleviated, as they can rest easy knowing that they’ll have access to health insurance. If you have recently discovered that you are pregnant (congratulations!) or if you are thinking about becoming pregnant and you don’t have health insurance, you’re probably wondering what type options are available.

Here’s a look at some of the different health insurance options expectant moms can consider for their maternity care.

Individual Marketplace Health Insurance Plans

If you don’t have insurance, you can purchase an individual plan through the health insurance Marketplace, where individual Obamacare plans are sold. Under the ACA, insurance companies are legally required to offer coverage that includes 10 essential benefits, and that includes maternity care. Prior to the Affordable Care Act, insurance companies considered pregnancy a pre-existing condition, which means that women who were pregnant and uninsured were either denied coverage or they were charged more.

As mentioned, that’s no longer the case. Under Obamacare, individual health insurance plans have to offer coverage for the following maternity services:

  • Outpatient care, including prenatal and postnatal doctor’s appointments, screenings (such as gestational diabetes), medications, and so forth.
  • Inpatient care, including hospital stays and any physicians fees that are incurred while receiving inpatient medical care.
  • Care for newborn babies.
  • Counseling for lactation needs, as well as breast pump rentals.

If you are going to purchase an individual Marketplace health insurance plan, it’s important to note that you will need to enroll during the Open Enrollment Period, which begins on November 15 of each year. Coverage purchased during Open Enrollment begins on January 1 of the following year; if you purchase an individual policy during the 2019 Open Enrollment Period, your coverage would begin January 1, 2020. It’s also important to note that while there is a Special Enrollment Period that will allow you to enroll any time of the year; however, you are required to have a qualifying life event, and becoming pregnant is not considered such an event.


While you can purchase health insurance that offers maternity care through the Marketplace, you may not be able to afford coverage. In that case, Medicaid may be an option to consider.

Medicaid is a federal and state health insurance program that offers free or low-cost medical care for qualifying individuals, such as low-income individuals. If you earn a certain percentage below the federal poverty level, if you are receiving other types of government-funded assistance, or if you have a disability, you may qualify for Medicaid. Every state has different eligibility requirements; but, many states have expanded their eligibility requirements, meaning that more people qualify for coverage.

Discount Health Insurance Plans

Lastly, you could consider investing in discount health insurance plan. While these plans are not actually health insurance, they do offer discounted rates on health insurance, including maternity care; depending on the plan, the cost of prenatal, labor and delivery, and postnatal care could be reduced up to 50 percent.

Discount health insurance plans aren’t available in all locations, however. The following states do not offer these kinds of plans:

  • Alaska
  • North Dakota
  • South Dakota
  • Wyoming
  • Vermont

But, if your state does offer a discount health insurance plan, if you enroll, after paying a monthly fee (similar to a premium for health insurance), you would receive reduced rates on medical services from medical care providers that participate in the plan.

The Bottom Line

Having a baby is a life-changing event, and it’s also a significant medical condition that requires proper health care. Fortunately, health insurance for maternity care has changed dramatically in the 21st century, as there are a lot more options available to expectant and soon-to-be expectant moms.

Whether you have recently found out that you are pregnant or you are thinking about starting a family, make sure that you weigh the different options that are available so that you can get the health care that both you can your little one need. If you aren’t sure where to get started or you don’t know what option would be the best for you, speak with an experience agent that specializes in health insurance. Together, you can discuss your needs and find coverage that will provide you and your baby with proper medical care.

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