Health Insurance When You're Pregnant

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Although it’s not as fun as designing your nursery, understanding your insurance is crucial for any mom-to-be.

You can avoid unexpected costs by knowing what your plan covers and what it doesn’t.

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Table of Contents

Prenatal Care

You will need to have a series of doctor visits and tests when you are pregnant. Depending on which plan you have, the services that your insurance covers, and the amount of money you will need to pay for them, will determine what you should do.

The Health Reform law stipulates that all new insurance must cover preventive medical services. This includes some for pregnant women. These services are covered by your insurance company, so you don’t need to pay anything extra.

If your plan was established after August 1, 2012, for example, your insurance company must provide coverage for services such as:

Test for conditions. Conditions that could cause harm to you or your baby include:

Hepatitis B
Gestational diabetes
Bacteriuria is a typical bacterial infection
Rh incompatibility is an immune condition that can occur during pregnancy.

Breastfeeding support. This includes training with a Breastfeeding expert during pregnancy or after delivery. Renting costs Breastfeeding Equipment may also be covered

Different plans may approach prenatal testing differently, such as ultrasounds. Cynthia Pellegrini says that while some plans might only cover one ultrasound in pregnancy, others will cover as many as the doctor orders. She is the senior vice president of government affairs and public policy for March of Dimes.

Pellegrini also states that most plans won’t cover amniocentesis for pregnant women who are at high risk of having a child with certain birth defects. This applies to women over 35 years old and those who have a family history of inherited diseases.

Different policies are available for different plans when it comes to giving birth. Pelligrini states that most employer-provided plans include prenatal care, routine labor, and delivery costs during the first few days at the hospital. There may be differences in coverage if the baby or mother has complications during birth and requires a longer stay.

Use Your Plan Wisely

You’ll need to know what you are expected to pay as you prepare for your baby. Your plan might have a deductible. The amount you contribute to your care each year prior to your plan paying is called a deductible.

You may also need to pay copayments on certain medical bills. You pay a set amount for each visit to a doctor or service, and copayments are a fixed dollar amount.

Your policy will tell you what is covered. Summary of benefits and coverage for health plans include information about what it covers and which bills you will need to pay. This explains the coverage of each service such as prenatal, postnatal, and delivery services in a hospital.

If you don’t understand the summary, contact your plan’s customer support phone number. This number is usually located on your plan ID card. You can also contact human resources for information on employer plans.

Here are some questions you might ask

What prenatal and/or postnatal services are included in my plan?
What are the deductible and copayment?

Get Your Baby on Your Insurance

Health care reform means that insurance plans you have through work and any new health plans can’t deny coverage to your child based on pre-existing medical conditions. Even if your baby was born with a medical condition, this applies. To get this coverage, you must enroll your baby within the first 30 days after birth. To add your baby to your insurance plan, call your company.