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.
Some of these services have been available at no cost since 2012. They're listed roughly in the order you would need them over the course of your pregnancy.
- Certain prenatal care
- Testing and counseling for sexually transmitted diseases, including HIV
- Testing for a blood condition known as Rh incompatibility
- Folic acid supplements (with a prescription), which help protect your baby from certain birth defects
- A wide range of prenatal tests, including anemia screening and screening for urinary tract infections
- Testing for gestational diabetes
- Screening and help to quit tobacco use
- Breastfeeding counseling and equipment
- Birth control after you've had your baby
What's covered for maternity care can vary from plan to plan. That's true if you get insurance through your work or buy it yourself. So for any plan you are considering, look at the details in its summary of benefits or call the insurance company for more information.