Affordable Care Act: Coverage for New Mothers

Are you having a baby, or did you just bring a little one home? Both of you can benefit under the Affordable Care Act (ACA).

Under the law, all individual and small employer insurance plans, including those you get through the Marketplace, must cover maternity and newborn care -- before and after your baby is born.* In the past, most plans sold outside your job didn’t offer much maternity coverage. Some didn't cover it at all.

The ACA doesn't spell out all of the specific benefits that must be covered while you're pregnant and after the baby is born. But many preventive care services must be covered without extra out-of-pocket costs, like co-pays, co-insurance, or deductibles. For moms, that includes preventive services for preconception and prenatal care and well-baby check-ups plus comprehensive lactation support, counseling, and breastfeeding equipment.

Preventive care also includes screening tests for anemia, gestational diabetes, hepatitis B, and a blood condition known as Rh incompatibility. It also covers folic acid supplements, if you have a prescription. Folic acid helps you to have a healthy baby. New moms can also get information about services to help with things like identifying and treating post-partum depression, stopping smoking, preventing violence, and more. There's no extra cost for any of these visits, tests, or supplements.

If you need help learning how to breastfeed, you can work with a lactation consultant, someone trained to help nursing moms and babies. You can also call the Office on Women's Health hotline for breastfeeding advice at 800-994-9662. Because each baby is different, you can ask for breastfeeding help with every child. The ACA requires most health plans to provide you with a breast pump to help you continue to breastfeed your baby even when you can’t be with him.

New moms and families who qualify may be able to get help from trained professionals who visit them at home. You can get information about services like identifying and treating post-partum depression, stopping smoking, preventing violence, and more. Home visiting services start during pregnancy and continue through the child's first three years.

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You can keep breastfeeding after you go back to work. As part of the Affordable Care Act, employers must give nursing moms who are eligible for overtime reasonable break times to pump breast milk. You can take advantage of this benefit for up to a year after your baby is born. Employers must also offer a private place for you to pump. This can't be a restroom, because they aren't private and can have germs. It has to be somewhere away from other people where you aren't likely to be disturbed.

If your company has fewer than 50 employees, it has to meet this rule unless the government has issued it an exemption. Work with your manager to find a private space for whenever you need to pump. Talk to your supervisor for ideas.

Because policies and coverage can be different from state to state and plan to plan, check your individual health care plan for details.

 

* Grandfathered health plans, those that existed before the Affordable Care Act was passed and have not significantly changed, are not required to offer maternity and newborn care. Check with your insurance company or HR department to find out if you’re in a grandfathered plan.

In addition, short-term health plans do not have to cover maternity care and almost none do. Short-term health plans are those that provide coverage for less than 12 months, although they can be renewed for up to 3 years.

 

WebMD Medical Reference Reviewed by Sarah Goodell on September 13, 2018

Sources

SOURCES: 

HealthCare.gov: "What are my preventive care benefits?" "What does Marketplace health insurance cover?"

Human Resources and Services Administration: "Women's Preventive Services Guidelines."

National Partnership for Women and Families: "Ten Reasons the Affordable Care Act is Good for Moms," "Why the Affordable Care Act Matters for Women: Better Care for Pregnant Women and Mothers."

United States Breastfeeding Committee: "Who is covered by the law?"

United States Department of Labor: "Break Time for Nursing Mothers."

WomensHealth.gov: "About Us," "Breastfeeding."

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