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Health Care Reform:

Health Insurance & Affordable Care Act

Insurance When You're Pregnant: FAQ

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 10 essential health benefits, including maternity and newborn care. But the details of what each plan will cover depends on two things:

  • Where you live. Your health plan choices will vary from one state to another, and even within the same state in different zip codes.
  • Which health plan you choose. Although all plans must cover the 10 essential health benefits, the details of how services are covered can vary; for example, all plans must help pay for prescription drugs, but one plan may cover the brand of medication you use while another does not.

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 made significant changes to their benefits and costs. They do not have to comply with this part of the law. Contact your insurance company or your employer to find out whether your plan is grandfathered.

These services are  listed roughly in the order you would need them over the course of your pregnancy.

  • Testing and counseling for sexually transmitted diseases, including HIV
  • Testing for a blood condition known as Rh incompatibility
  • Folic acid supplements, which help protect your baby from certain birth defects (with a prescription)
  • 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, review the details of the plan’s summary of benefits or call the insurance company for more information.

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