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Health Care Reform:

Health Insurance & Affordable Care Act

Insurance When You're Pregnant: FAQ

The Affordable Care Act makes it easier for pregnant women to get insurance to help pay for the medical care they need.

Can a health plan refuse to let me enroll because I'm pregnant?

No. In the past, insurance companies could turn you down if you applied for coverage while you were pregnant. At that time, many health plans considered pregnancy a pre-existing condition.

Health plans can no longer deny you coverage if you are pregnant. That's true whether you get insurance through your employer or buy it on your own.

What's more, health plans cannot charge you more to have a policy because you are pregnant. An insurance company can't increase your premium, based on your sex or health condition. A premium is the amount you pay each month to have insurance.

How can I get health insurance while I'm pregnant?

First, see if your employer -- or your partner’s employer -- offers health insurance. You will probably get the most coverage at the best price from a health plan from an employer. That's partly because most employers share the cost of insurance premiums with employees.

You can also shop for coverage in the health insurance Marketplace, which is also called an Exchange. You may also qualify for Medicaid  in your state based on your income.

In the Marketplace, you can:

  • Compare health plans side by side.
  • See if your income is in the range for financial help from the government. If it is and you otherwise qualify, you can use that money to lower the cost of your premiums. You may also qualify for lower out-of-pocket costs, such as deductibles, copays, and coinsurance.

You can also shop for coverage outside the Marketplace, but you will not qualify for financial help to lower the cost of premiums or out-of-pocket costs unless you are eligible and purchase coverage through the Marketplace.

Will I get the same coverage no matter which state I live in or which plan I choose?

Not necessarily. The law requires most private health plans to help pay for a basic set of maternity and newborn care benefits. An insurance plan calls these covered benefits. But the details of what each plan will cover depend on two things:

  • Where you live. Each state has rules about which insurance can be sold in that state, and each Marketplace chooses which plans will be sold through it.
  • Which health plan you choose, because each plan varies in terms of what is covered.

Make sure you carefully review your health plan’s summary of benefits, especially to see the specific set of prenatal and maternity services it covers.

What prenatal care can I expect to be covered by my health plan during my pregnancy?

All new health plans must cover certain preventive care with no out-of-pocket cost to you at the time of the visit. The exception is grandfathered health plans – those that were in existence before March 23, 2010 and that haven’t changed in certain significant ways. They do not have to comply with this part of the law. Contact your insurance company to find out whether your plan is grandfathered.

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