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Pregnancy and Health Insurance

May 17, 2019

Pregnancy can be such a wonderful time of life, but it can also be very stressful.  There’s a lot to do and a lot to plan for.  One of the most important things you can do is review your health insurance coverage.  Before you get pregnant, or as soon as you find out, look at your policy.  It’s important to know what your health insurance covers during this unique time.

The Affordable Care Act requires your insurance plan to cover these in-network essential benefits:

  • prenatal visits with no copay
  • labor and birth services
  • breast pumps with no copay
  • lactation consultation with no copay

Note: Has your plan been in place since March 23, 2010 or earlier?  If so, your plan may be considered "grandfathered" and may not be required to provide these essential benefits.  Call your health insurance provider to be sure.

Unfortunately, there are some services that may not be covered by your plan.  While your prenatal visit may be copay-free and covered by your health insurance, some of the services provided may not be.  For example, you may have to pay for a urine pregnancy test or blood work.  You’ll want to be sure that your obstetrician-gynecologist (OBGYN) or midwife is in-network and that any referrals they write for lab work or otherwise, are also to in-network providers.

If you’re recently pregnant and don’t have health insurance at all, contact your state’s marketplace.  You may qualify for a special enrollment period, Medicaid, the Children’s Health Insurance Program (CHIP), or another state assistance program.

You may also want to see if the hospital you use offers payment plans or sliding fee scales.  If you aren’t high risk, you may want to consider giving birth at a birthing center, rather than a hospital.  Birthing centers are often less expensive, provide sliding scales, and offer payment plans.

Health insurance is vital to have, especially during pregnancy, but try not to let the issue stress you out.  Stress isn’t good for you or the baby.  Get help from family members, coworkers, or even your human resources department.  This is not the time to try to do it all alone.


The information and materials herein are provided for general information purposes only and are not intended to constitute legal or other advice or opinions on any specific matters and are not intended to replace the advice of a qualified attorney, plan provider or other professional advisor. This information has been taken from sources believed to be reliable, but there is no guarantee as to its accuracy. This communication does not constitute a legal opinion and should not be relied upon for any purpose other than its intended educational purpose.

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