Pregnancy and health Insurance
First things first,
The first thing you need to know about pregnancy and healthcare insurance is that all health insurance Marketplace plans cover pregnancy and childbirth even if your pregnancy begins before your coverage starts. The services provided before and after your child is born (maternity care and newborn care) are essential health benefits, which means that all qualified health plans inside and outside the Marketplace must cover them.
If you don’t have health coverage, it’s important for you to know that health insurance makes it easier to get medical check-ups. Plus it is also easier to get screening tests to help keep both you and your baby healthy during pregnancy. Do you qualify for a Special Enrollment Period due to a life event like moving or losing other coverage? If you do, you may be able to enroll in a Marketplace health plan right now. Even though being pregnant doesn’t make you eligible, the birth of a child sure does.
As soon as your child is born, you should report their birth to your insurer via Marketplace by updating your application. This way, you can see that your coverage options and potential savings may change. You may qualify for more savings than you are right now. But always make sure to inform your Florida Health Agency agent before. Then we can guide you through this process and guarantee that you won’t lose your ACA coverage.
How do I know what specific benefits I have covered?
Every health plan provides a document called “Summary of Benefits and Coverage”. This summary will detail how your specific plan covers the cost of pregnancy and childbirth, plus all the other health services.
Are you are pregnant or plan on getting pregnant? Review this Summary with your Florida Health Agency expert agent to see how your plan covers childbirth. Or compare plans, if you are shopping for health insurance. When you do that, you will know what to expect when you are expecting your baby. Then you are less likely to get any surprise medical bills.
Don’t forget that these services are covered by major medical plans even if you got pregnant before your coverage starts. Thanks to Obamacare, pre-existing conditions are covered. This includes pregnancy.
It’s also important to know that if you have a grandfathered individual health plan (not the plan you get through your employer, it’s a plan you buy yourself), they aren’t required to cover pregnancy and childbirth. If this is your situation, call your Florida Health Agency agent to learn about your plan’s pregnancy and childbirth coverage. We are ready to help you.
Maternity services covered by health plans include:
- Lactation counseling and devices;
- Newborn baby care;
- Inpatient services – such as hospitalization, physician fees, etc.
- Outpatient services – These services include prenatal and postnatal doctor visits, laboratorial exams, medications, gestational diabetes screenings, etc.
It’s important to keep in mind that your coverage may vary depending on what plan and insurer you have. Additionally, out-of-pocket costs depend on several factors, such as the metallic tier of coverage you have, deductibles, co-payments, and which providers you choose.
What pregnancy benefits should you consider when shopping for health insurance?
If you are pregnant or planning to have a baby, some important things to consider about your current or any potential health insurance plan are:
- The covered cost of labor and delivery
- Your copay, coinsurance, and deductible amounts
- If prenatal testing is covered – amniocentesis, ultrasounds, and genetic testing
- Whether you need a referral to see a specialist / obstetrician / gynecologist from your primary care physician
- If you need to be pre-authorized to receive prenatal care
- Are private rooms covered during hospital delivery – or if you will need to share a room
- If non-traditional deliveries are covered – midwives and home-births (some health insurance plans consider home deliveries ‘not medically appropriate’ and will not cover them, so make sure to check with your insurer if you plan on not having your baby at the hospital)
Getting affordable maternity health coverage
Pregnancy and giving birth are mandatory health benefits under Obamacare. So getting affordable maternity health coverage is simple. However, it can be stressful and demanding.
You can start shopping for a health insurance plan that fits your budget and your coverage needs at any point in the year. However, you can only enroll either during the annual open enrollment period. This runs from November 1st through December 15th in Florida. Or you can enroll during a special enrollment period.
Florida Health Agency agents will help you compare your health insurance plan options. They will assist you to find the plan that suits you best. Keep in mind that shopping for health insurance with us is completely free. You will not pay more for a plan purchased through Florida Health Agency than you would if you were to purchase it anywhere else. Additionally, our health insurance experts are always here to help you with questions even after you’ve purchased a plan.