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Health Care Reform:

Health Insurance & Affordable Care Act

Insurance When You're Pregnant: FAQ

Am I eligible for Medicaid while I'm pregnant? continued...

The Affordable Care Act gives states new opportunities to expand their Medicaid programs to cover individuals who earn up to 138% of the federal poverty level ($15,654 per year for an individual in 2015). Not all states have done this. If your state has expanded the program and you meet the income and other eligibility criteria (for example, you are a resident of the state in which you are applying), you will still be covered under Medicaid.

If you no longer qualify for Medicaid after you give birth, you may be eligible for government assistance to buy a health plan through your state’s marketplace. Even if the open enrollment period – the time during which anyone can buy a health plan – is closed, there is a special enrollment period for people who qualify. If your Medicaid coverage ends, you will qualify for this enrollment period.

What questions should I ask before choosing a health plan to cover my pregnancy?

Ask how much your deductible will be. In general, your deductible goes down as your monthly premium payments go up. Also, take the time to understand other out-of-pocket costs that come with your plan, such as copays and coinsurance.

Ask which providers are in your plan’s network. You'll want to know which obstetricians, hospitals, and pediatricians participate in the plan. Your plan will likely only cover preventive services in full and at no cost to you if you receive your care from in-network providers.

Review the plan’s full summary of benefits and look it over closely. Pay close attention to any specific services you want or need to make sure they are covered by your health plan.

Once your baby is born, you qualify for a special enrollment period through the marketplace during which you can add your baby onto your policy. 

What happens after my baby is born?

You need to get in touch with your employer, insurance company, or state marketplace to add a child to your health plan shortly after you give birth. Many employers require you to add your baby to your policy within 30 days. Having a baby qualifies you for a special open enrollment period in your state’s marketplace and allows you 60 days to choose a plan for your baby or make changes to your existing plan. Depending on your income, your child may qualify for Medicaid or CHIP even if you have a policy through your employer or state marketplace.

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