Care for New Moms: What's Covered by Health Reform

As a new mom, you'll want to focus on enjoying your newborn. Easy access to health care should help. Several changes made by the Affordable Care Act will help make sure you and your baby get good care.

You generally have to use a provider in your plan’s network in order to receive these services.

After Delivery: Postpartum Care

Under the Affordable Care Act, health plans must make several types of preventive care available at no cost. For instance:

Well-woman visits. You get one free doctor's visit every year. It can help you get the recommended preventive care you need and other services to stay healthy.

Depression screening and treatment. Free screening for depression, including postpartum depression, is available. If you have postpartum depression, you can get treatment. Health plans must cover behavioral health and substance abuse treatment just as they would cover treatment for other medical conditions.

Quitting smoking. Smoking is bad for you. And second hand smoke can harm your baby. You can get free help to quit under health care reform.

Domestic violence screening and counseling. One in four women is a victim of domestic violence. Under the law, screening and counseling for domestic violence is covered at no cost for all women of childbearing age.

Contraception. Under the Affordable Care Act, plans must cover all FDA approved contraception methods without cost-sharing. Talk to your obstetrician about what method might be right for you.

If your health plan was in place before the Affordable Care Act became law and has made very few changes to its benefits, it may be considered a "grandfathered" plan. These plans can require you to pay a copay, coinsurance, or deductible at the time of the service. You must confirm whether your plan provides preventive services at no cost.

Breastfeeding Support

Breastfeeding is one of the best ways for you to protect your health and the health of your newborn. Because of that, one goal of health reform is to make breastfeeding easier. 

Support, supplies, and counseling. Under the Affordable Care Act, health plans must provide free breastfeeding help from trained counselors. You can also get a breast pump free of charge through your plan. But you do not get to choose what kind of pump, electric or manual. That's up to your insurance company. It can also choose whether you get to keep the pump or use a rental.

Breastfeeding in the workplace. By law, if you are an hourly paid worker, you now must get a reasonable break time during your workday to express breast milk. Your employer also has to provide a private place where you can pump your breast milk without interruption from others. A bathroom is not considered an appropriate space. You have this benefit for up to one year after your baby is born.

Continued

Selecting the Right Plan

If you are pregnant or are a new mom, you’ll want to closely examine the specific services and medications covered as well as each plan's provider network when you're comparing health plans in your state's insurance Marketplace. Here are some things to consider:

  • Does the plan limit the number of prenatal visits?
  • What diagnostic tests are covered?
  • Can I use a doula or a midwife under my plan?
  • Will the plan cover a home birth?
  • How high is my monthly premium?
  • What are the copays and deductibles?
  • Are my obstetrician and pediatrician in the plan’s network?

Changing Plans

Giving birth or adopting a child entitles you to a special open enrollment period to shop for and purchase coverage on your state’s insurance Marketplace. This means if you missed the annual open enrollment period you can still sign up for a new health plan or change your existing plan after giving birth or adopting a child. You have 60 days after the birth or adoption of your child to make changes to your health plan. So, if after you have your child, you discover your preferred pediatrician is not in your plan’s network, you can make a change.

WebMD Medical Reference Reviewed by Sarah Goodell on July 18, 2018

Sources

SOURCES:

U.S. Department of Health and Human Services: "Affordable Care Act Rules on Expanding Access to Preventive Services for Women;" "Health Reform: Overview of the Affordable Care Act;" and "Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans."

U.S. Preventive Services Task Force: "USPSTF A and B Recommendations."

National Women's Law Center: "Women's Preventive Services in the Affordable Care Act: Frequently Asked Questions."

Kaiser Family Foundation: "Health Reform: Implications for Women's Access to Coverage and Care."

U.S. Department of Labor: "Break Time for Nursing Moms."

National Partnership for Women and Families: "Why the Affordable Care Act Matters for Women: Better Care for Pregnant Women and Mothers" and "Why the Affordable Care Act Matters for Women: Health Insurance Coverage for Lower- and Moderate-Income Pregnant Women."

© 2018 WebMD, LLC. All rights reserved.

Pagination