Key takeaways:
Health insurance typically covers prenatal care services such as blood tests, healthcare appointments, and ultrasounds. Your insurance may also cover the cost of delivery, postpartum checkups, and newborn care.
Review your health insurance policy to find out what’s covered. You should also talk to your healthcare provider to get a better understanding of what services and products you may need.
If your insurance covers an item or service, you may still need to pay coinsurance, copayment, or a deductible.
Being pregnant can be an exciting time, but it can also be costly.
If you have health insurance, your plan will cover the basics of prenatal, delivery, and postpartum care in most cases. Your insurance plan may also cover additional items based on your medical needs and the type of insurance plan you have.
It’s important to read your health insurance policy and ask your provider what’s covered. This can save you money and stress during one of the most important times of your life.
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What health insurance should I get if I’m pregnant?
All qualified and most employer health insurance plans must cover essential health benefits like pregnancy and childbirth services. This is a requirement under the Affordable Care Act (ACA).
The type of health insurance plan you have will determine the exact benefits you will receive. Even if your plan is offered by your employer rather than on the ACA marketplace, it likely provides the minimum essential benefits.
If you are pregnant and don’t have insurance yet, it’s not too late to obtain coverage. Under the ACA, health insurance plans are not allowed to turn you down for being pregnant.
Here are some of the different types of insurance plans that may be available to you if you are pregnant:
Affordable Care Act (ACA) marketplace plan
Private (off-exchange) health plans
Before selecting a health plan, it’s important to learn more about costs and coverage to avoid an unexpected bill later.
How much does pregnancy cost? Find out about the factors that affect the cost of pregnancy and get tips to reduce some of your expenses.
Does insurance cover midwife care? Read about the services midwives provide and which insurance plans cover midwife care.
Budgeting for a new baby: Getting ready for your newborn involves more than bibs, bottles, and burp cloths. Learn more about what costs to expect during your baby’s first year.
What items and services does insurance cover for pregnant women?
Your insurance coverage for items and services you need while pregnant will vary based on your plan. Before you visit your healthcare provider or obtain a medical treatment or procedure, you should do the following:
Review your plan’s summary of benefits and coverage. This document will tell you what your plan covers. You can get a copy of your summary of benefits and coverage from your health insurance plan provider.
Contact the customer service department. If you don’t understand your summary of benefits and coverage, you should reach out to your plan provider to ensure you get your questions answered.
Get an estimate of your costs. Even if your insurance company covers an item or service, they may not cover the full cost. It’s a good idea to find out how much you may need to pay for services that are covered under your health plan.
Your insurance will typically cover medically necessary services for your pregnancy. But some services may be considered elective, which means you’ll most likely have to pay for all or a majority of the costs out of pocket. Speak with your healthcare provider if you feel you need something they have not ordered, and they may then recommend it so you can get it covered by insurance.
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Below are a list of common prenatal, delivery, and postpartum items that are typically covered by insurance.
Prenatal care
Prenatal care can take place during pregnancy to ensure you have a healthy birth. Common items covered by insurance include:
Birthing classes
HIV counseling
HIV screening
Genetic testing for chromosomal or genetic abnormalities that could indicate conditions like Down syndrome
Gestational diabetes testing
Maternity compression garments
Pregnancy tests (blood or urine tests performed by a lab)
Prenatal vitamins
Preventative testing (hepatitis B & C, syphilis)
Routine check-ups with your midwife or OB-GYN
Sexually transmitted infection (STI) counseling
Ultrasounds
Visits with your healthcare provider
Delivery
Most health insurance for pregnant women covers delivery in the most common setting, which is a hospital. Alternatively, some people who have low-risk pregnancies choose to deliver in a birthing center, which may not be covered by every insurer. Regardless of setting, there may be costs for physicians, nurses, or midwives to attend the birth, some medication costs, and facility costs.
Common delivery costs typically covered by insurance include:
Cesarean section (C-section)
Hospitalization expenses (including equipment and supplies, the delivery room, and medications)
Birthing center charges (if the delivery is there instead of a hospital)
Newborn baby care
Physicians’ fees (including the OB/GYN and anesthesiologist)
Vaginal delivery
Postpartum
Once the baby is born, the postpartum period begins. It lasts until your body has recovered from the birth, which can be 6 weeks or longer. During this time, both the person who gave birth and the baby will need extra care.
Postpartum costs that may be covered by your insurance plan include:
Breast milk storage bags
Breast pump tubing and supplies
Breast pumps
Breast shields
Lactation consultant
Postpartum compression garments
Postnatal care
Postpartum depression screening
Does insurance cover fertility treatments for pregnant women?
Some insurance plans cover infertility services, such as in vitro fertilization, but the Affordable Care Act doesn’t require it. Almost 20 states require some coverage for infertility services, but the details vary. Check with your state and then your insurer to see what specific services and coverage limits your plan offers.
Here are some fertility items and services your insurance may cover:
Ovulation monitor
Lab tests
Semen analysis, hormone or genetic testing, or testicular biopsy
Ultrasound, MRI or CT scans, and X-rays
Diagnostic procedures for women like ovulation and ovarian reserve tests, hysterosalpingography, and imaging
Fertility medications like clomiphene and letrozole
Surgery to correct structural issues or for egg retrieval
Intrauterine insemination (IUI)
In vitro fertilization (IVF)
Cryopreservation
What other items may be covered by your health insurance?
Many things can happen during pregnancy, and you may have specific needs. If your situation requires them, many of these items and services could be covered:
Acupuncture for pregnancy-related nausea
Antibiotics (to treat mastitis, a common infection occurring during breastfeeding)
Baby doppler (to check fetal heartbeat during telemedicine visits)
Breast milk transportation expenses
Diaper rash treatment (treatment for an infection, not preventive diaper creams)
Genetic counseling
Genetic testing before conception (to determine carrier status for genetic conditions)
High-risk pregnancy services (extra tests, procedures, hospital visits, or stays)
Medication to ease morning sickness
Newborn intensive care unit (NICU) services
Treatment for miscarriage or chemical pregnancy (including physician visits, medication, and dilation and curettage, or D & C, if needed)
Tubal ligation
Vasectomy
What out-of-pocket costs should you plan for?
Even if your insurance covers an item or service, you may need to pay for the following:
Copayment: A copay, or copayment, is the set amount you need to pay for a service before your insurance kicks in to cover it. For example, you could have a $25 copay for doctors’ visits, but a $30 copay for another service like physical therapy sessions.
Coinsurance: Some insurers use coinsurance to calculate how much they cover for a service. Coinsurance is expressed as a percentage. For example the insurer may cover 80% and the patient covers 20%.
Deductible: Your deductible is the amount you must pay for covered services before your insurance starts to cover the agreed portion of the charges.
If you visit an out-of-network provider for services, you may pay a higher percentage of the bill or the entire cost.
Most plans, including marketplace health plans, must cover preventive health services like maternal depression screening for free, even before you meet your annual deductible.
What services and products are less likely to be covered?
If your healthcare provider says it’s medically necessary, you may be able to get a prenatal massage or other treatments approved that are not usually covered in your plan. You may need a note from your healthcare provider for some less common items.
Certain plans, including some Medicaid plans, may include extras like dental care insurance for pregnant women or doulas to help with the birth or postpartum periods. Although the items listed below are less likely to be covered, it doesn’t hurt to ask your insurance plan provider.
Pregnancy pillow
The bottom line
If you are pregnant, insurance may cover many common costs related to prenatal, delivery, and postpartum. It’s important to review your health insurance policy to find out what your specific plan covers. Even if your insurance plan covers an item or service, you should find out how much you may need to pay out of pocket so you can plan accordingly.
Why trust our experts?
References
BlueCross BlueShield. (2020). Telemedicine has a silver lining for pregnant women during COVID-19.
Doula Series Footnotes. (2021). Medicaid coverage of doula services in the United States.
Garvin, J. (2022). Pregnant, postpartum Medicaid enrollees to have dental coverage for at least 60 days after pregnancy. American Dental Association.
HealthCare.gov. (n.d.). Health insurance rights & protections: Summary of benefits and coverage.
Magnolia Birth House. (n.d.). Frequently asked questions.
MedlinePlus. (2021). What are the uses of genetic testing?
National Conference of State Legislatures. (2021). State laws related to insurance coverage for infertility.
TriCare. (n.d.). Pregnancy care.
Salganicoff, A., et al. (2019). Coverage for abortion services in Medicaid marketplace plans and private plans. Kaiser Family Foundation.
State of New Jersey Department of Human Services, Division of Medical Assistance & Health Services. (2021). Medicaid/NJ FamilyCare coverage of doula services.
U. S. Department of Health & Human Services. (2022). Preventative care.
Weigel, G., et al. (2020). Coverage and use of fertility services in the U.S. Kaiser Family Foundation.
