Health Insurance When You're Pregnant

From the WebMD Archives

It's not as much fun as planning your nursery, but understanding your health insurance is important for every mom-to-be.

Knowing what your plan covers -- and what it doesn't -- can help you avoid surprises down the road.

Prenatal Care

When you're pregnant, you'll need a series of doctor visits and tests to check your health and your baby's health. Which services your insurance covers, and how much you'll have to pay, depends on your plan.

The health reform law requires that new health plans cover certain preventive medical services, including some when you're pregnant. You won't have to use your own money for these services as long as the doctor is on the insurance company's "in-network" list.

For example, if you have a plan that started on or after Aug. 1, 2012, your insurance company must cover services such as:

Testing for conditions. This includes conditions that could be harmful to you or your baby, such as:

Breastfeeding support. This includes training from a breastfeeding expert during pregnancy or after delivery. Costs for renting breastfeeding equipment may also be covered.

Plans may differ in how they approach prenatal testing, such as ultrasounds. "Some plans may cover just one ultrasound during pregnancy, while others will cover as many as the physician orders," says Cynthia Pellegrini. She is senior vice president of public policy and government affairs for the March of Dimes.

Also, most plans will only cover amniocentesis for women who are considered at high risk of having a baby with certain birth defects, Pellegrini says. This includes women ages 35 or older or those with a family history of an inherited disease.

When it comes time for giving birth, plans have different policies. "In general, most employer-provided health plans cover prenatal care and routine labor and delivery costs for the first one or two days in the hospital," Pelligrini says. "However, if the mother or baby have complications during delivery and require a longer stay, there may be significant differences in what's covered."

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Use Your Plan Wisely

As you get ready for your baby, you'll want to understand what you're expected to pay for yourself. For example, your plan may have what's called a deductible. A deductible is the amount you pay toward your care each year before your plan starts paying.

Also, you may have to pay copayments for some medical bills. Copayments are set dollar amounts that you pay for each doctor visit or medical service.

To find out what's covered under your plan, read your policy. Health plans have a summary of benefits and coverage that explains what the plan covers and what bills you need to pay on your own. It explains how the plan covers each type of service, such as prenatal and postnatal care provided in a doctor's office, or delivery and inpatient services provided in a hospital.

If you do not understand the summary, call your plan's customer service phone number, usually found on your plan ID card. For information about employer plans, you can also contact the human resources department.

Some questions to ask:

  • What prenatal and postnatal services are covered under my plan?
  • Will I have a deductible or copayment for these services?

Get Your Baby on Your Insurance

Under health care reform, insurance you get through work and new health plans cannot deny coverage to your baby based on pre-existing conditions. This is true even if your baby is born with a health issue. But you must enroll your baby within 30 days of birth to get this coverage. Call your health insurance company to find out how to add your baby to your plan when the time arrives.

WebMD Feature Reviewed by Charlene Frizzera on April 26, 2013

Sources

SOURCES:

Healhcare.gov: "Pregnant Women and the Affordable Care Act," "Insurance Basics," "Services Covered and Summary of Benefits and Coverage (SBC),"  "Preventive Services Covered Under the Affordable Care Act."

U.S. Department of Health and Human Services Health Resources and Services Administration: "Women's Preventive Services: Required Health Plan Coverage Guidelines."

Cynthia Pellegrini, senior vice president of public policy and government affairs, March of Dimes.

American College of Obstetricians and Gynecologists: ACOG News, Sept. 7, 2012.

March of Dimes web site: "Prenatal Care."

American Society for Reproductive Medicine: "State Infertility Insurance Laws."

Womenshealth.gov: "Health Care for Baby."

Centers for Medicare and Medicaid Services: "Summary of Benefits Coverage (SBC) Template (Standard Format)."

© 2013 WebMD, LLC. All rights reserved.

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