What You Need to Know About Health Insurance if You’re Trying for a Baby

Thankfully, all major health insurance plans today include pregnancy coverage. Coverage typically consists of all your prenatal care, inpatient services, postnatal care, and care for your newborn. 

These services were introduced in 2014 as part of the Affordable Care Act to help expectant mothers access the insurance they need to care for themselves and their newborns. Understanding how health insurance works concerning pregnancy is essential since every pregnancy is unique and will incur different costs.

Why health insurance is essential during pregnancy

Health insurance can help you to pay for the cost of pregnancy, including your maternity care and birth costs. Purchasing a plan with set out-of-pocket limits means you can budget for your care needs and cap your spending, regardless of the level of care you need.

The costs of having a baby are more than just the birth costs. You also need to consider check-ups, tests, and prenatal care expenses. According to FAIR Health, the average price for the birth for a vaginal delivery is between $5,000 to $11,000 in most states. For a c-section, you’re looking at between $7,500 to $14,500. If you experience complications during the birth, it’s likely to increase the cost significantly. The price can vary depending on complications with the delivery, where you choose to have your baby, and the doctor and hospital you choose. 

Your insurance generally covers some of these expenses, but you may still need to consider covering the remaining costs as part of your out-of-pocket maximum cost share. This amount varies depending on if you’ve met your deductible, whether you have coinsurances or copays, if you’re seeing a doctor out of your plan’s network, and many other factors. It can also affect your costs if you have a complicated birth and your baby needs to stay in an ICU or NICU.

What’s covered when you’re pregnant?

Individual health insurance plans are required to cover various maternity services, including:

Your pre and postnatal doctor visits

● Medications related to your prenatal care

● Some tests and screenings 

● Hospitalization

● Breast pump rental

Your maternity health insurance plan is also required to offer preventative services without copays or coinsurance. You can access these services at no cost even if you haven’t met your deductible:

● Some supplements, such as folic acid

● Screening for Hepatitis B, anemia, and urinary tract infection (UTI)

● Gestational diabetes screening, typically done between weeks 24 to 28 of pregnancy

● Rh incompatibility screening and necessary follow-up testing if you’re at risk

● Tobacco counseling and education

Once you have your baby, they’ll receive routine newborn preventative care. You can also access breastfeeding support from a lactation consultant free of charge. You will need to see doctors and visit hospitals that take your insurance to make sure these costs are covered by your plan, except if you need to access emergency care.

Discovering your benefits

Your health insurance provider must provide you with Summary of Benefits and Coverage documents. These documents detail how your plan covers the costs related to pregnancy and childbirth. Reviewing these documents can help you know what costs to expect and help you plan, so you don’t incur unexpected and expensive medical bills.

Unless you have a grandfathered individual health plan you purchased before 2014, your health insurance will cover maternity care. If you think you have a grandfathered health insurance plan, it’s worth calling a health insurance agent or your insurance company to find out more about what pregnancy and childbirth coverage is included in your plan.

What to look for in a health insurance plan

When researching plans, it’s essential to consider a few things. For example, how likely will you need a referral to see a specialist? What coverage is provided for prenatal testing? Do you need pre-authorization to receive any prenatal care? And are non-traditional deliveries included? These non-traditional deliveries may cover things like home births or midwives. If you’re interested in a non-traditional birth, it’s essential to check if your policy provides coverage. You should also consider whether you want a private or shared room during hospital stays. 

What if you don’t have insurance

You may qualify for government health insurance programs if you’re already pregnant and don’t have insurance. There may also be free or discounted care options, depending on where you live in North Carolina. 

At Health Plans of NC, we recommend getting health insurance coverage as soon as possible to help you cover the costs of your pregnancy and birth.  Our agents provide quotes and support to help you choose the best coverage for your needs. You may also be eligible for Medicaid, so it’s a good idea to check. If you qualify for Medicaid, you’re eligible to enroll in an insurance plan at any time of the year. 

Choosing the right plan

Purchasing the right health insurance when you’re trying to get pregnant can help ensure that not only do you have access to the care you need but you’ll save money. A health insurance plan that works for you when you’re not pregnant may not work for you when you are, meaning you could end up paying a lot in medical bills, coinsurance, or copays related to the birth of your child. Planning and purchasing a plan that considers your pregnancy can help you save in the long run.

Pregnancy is not a qualifying life event in North Carolina, so you cannot enroll in an individual health insurance plan outside the Open Enrollment Period. If you’re trying for a baby, it’s a good idea to enroll during the Open Enrollment Period, so you don’t miss out. The Open Enrollment Period typically runs from November 1st through January 15th in North Carolina. You may also be eligible for a Special Enrollment Period if you meet certain life events, such as getting married.

Get help from an expert

Talking to an experienced health insurance agent who understands the best health insurance for pregnancy is an excellent idea. At Health Plans of NC, our agents can research insurance for pregnancy to get you the right plan for your care needs. Our health insurance agents NC have helped thousands of local North Carolina residents get the right insurance for their new families. Get in touch with us today to find out more.