What You Should Know About Maternity and Newborn Health Insurance

By Kathryn Hawkins


Whether you're pregnant or thinking about starting a family, it's important to make sure you have the right health insurance plan to cover your maternity care and the future addition to your family.

Heading toward parenthood without proper health insurance could leave you with a lifetime of debt. Here are some basics to get you started:

5 factors to consider for maternity and newborn health insurance

1. Maternity and newborn care costs

Maternity care -- particularly labor and delivery -- can be expensive if you have to pay out of pocket: According to a recent report from Childbirth Connections, a nonprofit advocate for maternity care, the average hospital charge billed to insurance providers for an uncomplicated birth is more than $10,000.

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And if you need a Caesarean section and have complications that result in a longer hospital stay (such as an infection), that cost easily can jump to about $24,000.

What's worse is that these price tags don't factor in associated costs, such as prenatal care, ultrasounds or other forms of testing, such as an amniocentesis.

2. Coverage options under Obamacare

Until recently, women with income levels too high to qualify for federal or state aid and who didn't receive group health insurance through an employer had few -- or no -- affordable options for health insurance to cover their maternity care and delivery.

Obamacare has made it much easier for women to obtain high-quality maternity coverage, whether or not they're already pregnant.

The law requires that all health insurance plans include coverage for maternity care, and doesn't let plans impose mandatory waiting periods before fulfilling claims for maternity-related care.

3. Insurance premium and deductibles

Given the high costs of having a baby, you may max out the individual deductible on your health insurance plan when you go into labor. If you're able to make a switch, consider choosing a plan that has higher premiums but lower deductible payments.

On the Obamacare health insurance marketplaces, also known as exchanges, the difference between the bronze- and gold-level plans may range from $100 to a few hundred dollars per month (based on your age and location), but a bronze plan will only cover 60 percent of your costs, while a gold plan covers 80 percent of costs.

4. Enrollment for newborn coverage

Once you give birth, your newborn will automatically be eligible for coverage from your insurance provider under the Health Insurance Portability And Accountability Act, and you'll have a window of at least 30 days to enroll your new child in your family's plan.

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This doesn't mean all expenses associated with the baby will apply to your individual plan, however. Instead, you'll be responsible for paying an additional premium for the baby's health coverage, and expenses that go beyond what is covered by your plan (which might include newborn care during your time in the hospital) will be applied to his or her deductible.

5. Medicaid qualifications

Depending on your household income level, you may be eligible for Medicaid through the course of your pregnancy even if you wouldn't qualify under normal conditions (this has been the case since 1987, under a federal ruling). Even if you're already pregnant when you apply for coverage, if accepted, your pregnancy-related medical bills for the past three months will be covered retroactively.

Your child may also be eligible for Children's Health Insurance Program (CHIP) coverage; check out your state's income requirements to find out whether your family will qualify for free or low-cost coverage.

Editor's note: This is an updated version of an article originally published on Dec. 31, 2013.