Health Insurance for Unborn Child
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UPDATED: Mar 19, 2020
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- Under the Affordable Care Act, all marketplace and Medicaid plans are required to cover pregnancy and the birth of your child
- If you already have a Marketplace plan when your child is born, you can add them to your plan or enroll in a new one
- You will qualify for a special enrollment period when your child is born to update or enroll in your marketplace plan
- If you have qualifying employer-based coverage, maternity care, and childbirth are still covered
- You should be able to add your newborn child to your employer coverage but you will have to speak to the human resources representative at your job about your options
- If you do not have insurance, you should apply for Medicaid or the Children’s Health Insurance Program to cover you and your child
All health insurance plans that meet the minimum essential coverage guidelines under the Affordable Care Act are required to cover maternity care and childbirth because they are considered essential health benefits. In most cases, this includes coverage for labor, delivery, and the medical care of the newborn baby.
If you were pregnant before your health insurance coverage started, your plan is still required to cover your maternity and childbirth needs. ACA regulations forbid insurance companies from refusing coverage due to a pre-existing condition, which includes pregnancy.
If you have an individual grandfathered insurance plan, you may not be entitled to all of the rights and protections under the Affordable Care Act. This means that your plan may not be required to cover your pregnancy and childbirth. You will have to speak to your plan’s administrator.
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Will my newborn child be covered by my health insurance?
If you have a marketplace plan, you can either add your child to your current plan or enroll in a new one when the baby is born. You are entitled to a special enrollment period when the child is born to enroll them in a plan or update your existing one.
You will have 60 days after the child is born to enroll in a new plan. Your coverage will start the day the child was born even if you do not enroll in the plan until the 60th day afterward.
These circumstances will apply if you are adopting or fostering a new child, as well. When you apply for a marketplace plan, you will be notified if you are eligible for any premium tax credits or other cost-sharing savings based on your annual income.
If you miss your 60-day window, you will have to wait until the next open enrollment period to get health insurance for your child so make sure you apply in time!
If you have an employer-based health insurance plan, you should be able to add your child to the plan. You will have to speak directly to your human resources representative but most employers must offer coverage for employee’s dependents until the age of 26.
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What is Medicaid and the Children’s Health Insurance Program?
If you do not have insurance and are low income, you should apply for Medicaid or the Children’s Health Insurance Program for you and your baby. You do not have to wait for open enrollment to apply for Medicaid because you can apply at any time of the year and your coverage will begin immediately if you are eligible.
In states that have expanded Medicaid, you will qualify if your income is 138 percent of the federal poverty level or less. If your state did not expand Medicaid, you may still qualify based on additional determining factors.
Medicaid programs are administered by each individual state so the benefits may vary, but all versions of Medicaid will cover the essential health benefits including maternity and childbirth.
You can apply for Medicaid and the Children’s Health Insurance Program in one of two ways. You can fill out an application through the healthcare exchange marketplace. If it looks like you are eligible in your state, the marketplace will forward your information to your local Medicaid agency.
You can also contact your Medicaid agency directly and a representative will guide you through the process.
Will the Children’s Health Insurance Program cover my pregnancy and childbirth?
The Children’s Health Insurance Program is typically a low-cost option for children of lower income families that earn too much to qualify for Medicaid. CHIP covers all of the essential health benefits and may cover additional services in some states. You can apply at any time of year.
The cost of CHIP coverage will vary depending on the state. Some states will charge a monthly premium, but it will never cost more than 5 percent of your total annual income for the year, regardless of the state. Wellness visits and trips to the dentist are free under CHIP, but there may be copayments for other services.
In some states, the Children’s Health Insurance Program will cover pregnant women. For example, if you live in Texas, you may be eligible for the CHIP perinatal program.
The CHIP perinatal program provides coverage for labor, delivery, and the first few months of your child’s life. It also covers 20 prenatal visits, prenatal vitamins, and two visits to the doctor for you after you have the child.
How do I get health insurance for my unborn baby?
All qualifying health insurance plans must offer you coverage for maternity care and childbirth. If you have a marketplace plan, you should qualify for a special enrollment period to update your insurance plan and include your child after birth.
You will have 60 days to do this and coverage will begin the day of birth. If you do not have insurance, you should apply for Medicaid or the Children’s Health Insurance Program to cover you and your child.
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