How To Baby-Proof Your Health Insurance Checklist
Key Takeaways
- Health insurance may cover some or all maternal and paternal services, but the amount is not standard across all policies.
- Having a child qualifies you for a Special Enrollment PeriodA Special Enrollment Period is an opportunity outside of a standard enrollment period in which your specific circumstances allow you an opportunity to make changes to your Medicare-related coverage. , where you can enroll in a new plan for 60 days after your child is born.
- Several factors cause more out-of-pocket costs during your pregnancy. You should review your coverage and costs with your carrier or provider.
Welcoming a new child is always exciting, but it also means there’s work to be done. Getting ready before they arrive can mean the difference between settling in or losing sleep (OK, that’ll probably happen either way).
The same goes for your health insurance. Here’s an easy checklist to baby-proof your coverage and help you sleep easy–while you still can.
What Medicare coverage is right for my specific situation?
1. Know What’s Covered
As an expecting mother, there are many services available to you — some even with no out-of-pocket cost. All health insurance plans must cover maternal[i] and newborn[i] care. The ACAThe Affordable Care Act (ACA) is healthcare reform to reduce the number of uninsured Americans by making coverage more affordable. Also known as The Patient Protection and Affordable Care Act, the ACA also requires insurance companies to cover preventive care and other essential health benefits. Also known as “Obamacare.” includes services before and after birth. Covered services include:
Mothers
- Gestational diabetes screenings
- Preeclampsia prevention
- Folic acid supplements
- Breast pumps
- Breastfeeding consultations
- and many more
Newborns
- Immunizations
- Childbirth
- Blood screening
- Hearing screening
- Hypothyroidism screening
- and many more
2. Choose your OB-GYN Carefully
Always make sure your OB-GYN is in your health insurance company’s provider network. Also, check that your insurance covers the hospital your OB-GYN uses for deliveries. You can be stuck with the entire bill if you deliver at a hospital that isn’t in your network.
Looking for dental, vision and hearing coverage?
3. Tell Your Insurance Company the Good News
Let your insurance company know you’re having a baby, and review your benefits so you take advantage of what is available to you. You may be unaware of available options in your policy. For example, your plan may let you use a midwife for your child’s birth. Your health insurance company can confirm that your doctors and delivery site are in-network. They’ll be your go-to source for info about how your pregnancy is covered. And getting the most out of your policy means receiving invaluable prenatal and maternal care.
4. Figure Out Your Out-of-Pocket Costs
While many maternity services are covered, don’t assume everything is. Review which services you’ll need to pay out of your pocket. Know how much you need to spend to meet your deductible and begin cost-sharing. Know what you’ll be required to pay, including:
5. Keep Up With Your Prenatal Care
Staying on top of your prenatal health will help you and your baby stay healthy during pregnancy. All health insurance policies cover a list of services you can receive at no cost. Folic acid supplements, fetal heartbeat monitoring, and specific blood tests are all examples of covered maternal and prenatal services.
Ready for a new Medicare Advantage plan?
6. Reevaluate Your Health Insurance Plan Options Following the Birth
Having a baby is a Qualifying Life Event (QLE)Qualifying Life Events (QLE) are life changes that allow you to enroll in a new health insurance plan during a Special Enrollment Period. These include having or adopting a child, losing other coverage, marriage, a change of income and moving. that makes you eligible for a Special Enrollment Period. Your QLE enrollment window starts when your baby is born and remains open for 60 days. If you think you’ll be seeing the doctor more often with a young one, you might consider a plan with the lower deductible and out-of-pocket maximum.
FAQs
Can you be denied health insurance if you’re pregnant?
How much does it cost to have a baby with health insurance?
What if I don’t have health insurance when I’m pregnant?
Sources
- Preventive care benefits for women. Healthcare.gov.
- Preventive care benefits for children. Healthcare.gov.
- Having a Baby May Cost Some Families $4,500 Out-Of-Pocket. MichiganMedicine.org.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.