What Does Insurance Cover During and After Pregnancy?
One of the biggest unknowns when it comes to pregnancy and parenthood is the financial costs. For many, personal finances are the reason why they feel unprepared or do not want to become a parent. Luckily, insurance can help cover some of the costs associated with prenatal care to help ease the financial burden of welcoming a new baby into your life. But what exactly will insurance cover? While we can break down the common costs and procedures that insurance will cover, it is always best to check with your insurance agency for exact details and numbers.
Legally, Most Insurance Companies Have to Pay for Prenatal Care
Under the Affordable Care Act (ACA), most insurance companies are legally required to provide coverage for preventative and prenatal care. This includes most employer sponsored plans and all Medicaid and Marketplace plans. Most health plans must cover prenatal visits with no extra cost. These include routine checkups, screenings, and lab tests. Although your specific plan may cover most or all of the cost, there could also be a small copay for certain services.
Your plan may also cover specialists if you develop high-risk conditions. This could include visits to a maternal-fetal medicine doctor or nutrition counseling.
Insurance Coverage for Delivery
All insurance plans sold in the Health Insurance Marketplace must cover labor and delivery services. This means hospital expenses for a vaginal or cesarean birth. You may have copays or coinsurance, so review your plan’s summary of benefits to know your share of the cost. Anesthesia, such as an epidural, is usually included. If you choose a birth center or a home birth, coverage can vary. Many plans will cover births outside the hospital if you meet certain criteria. Call your insurer to confirm where you can deliver at the best cost.
Insurance Coverage After Pregnancy
The postpartum period is a key time for both mom and baby. Most plans cover a checkup around six weeks after birth. This visit checks your physical recovery and addresses any concerns, like bleeding or pain. Your health care provider can also give guidance on exercise, nutrition, or birth control. Newborn care is also covered by most plans. You often have 30 to 60 days after birth to add your baby to your policy. Well-baby visits, immunizations, and developmental screenings are typically covered with no cost-sharing.
Mental Health and Lactation Support
Postpartum mood changes are common and can include depression or anxiety. Many insurance plans cover mental health services. This could mean counseling or therapy sessions with a licensed professional. If you feel overwhelmed, reach out to your provider or talk line right away.
Lactation support is another benefit that can be covered. Certified lactation consultants, breast pumps, and breastfeeding classes are usually included. Check with your plan for specific breast pump models and whether you need a prescription or prior approval.
How to Check Your Coverage
Understanding your benefits starts with your Summary of Benefits and Coverage (SBC). Look for sections on maternity care, newborn care, mental health, and preventive services. The SBC will list any copays, coinsurance, or deductibles you must pay. If you still have questions:
- Call the customer service number on your insurance card. Ask about pregnancy and postpartum services.
- Visit your insurer’s website and log into your member portal. Search for maternity or preventive care.
- If you have Medicaid, call your state’s Medicaid office for details on covered benefits.
Does Insurance Cover Abortions?
There are no federal laws that require insurance companies to cover abortions, meaning that it is up to the individual companies to determine whether or not they want to cover it. This leaves a large spectrum of coverage, with some covering abortions under any circumstance, and others choosing not to cover abortions for any reason. Medicaid will not cover abortions unless it is a result of a rape or incest.
Do I Need Insurance to Receive Care at Care Net Milwaukee?
It can be complicated to figure out what your insurance will cover and what it won’t. What isn’t complicated, however, is receiving care at Care Net Milwaukee. Our clinic provides our services completely free of charge – that means that there’s no cost and no insurance necessary. If you are unsure if you are pregnant, or recently found out you are pregnant, schedule an appointment with Care Net today to get yourself started on the right foot. During your appointment, we can also refer you to low cost providers in the area.