What Maternity Services Are Covered?
The ACA made sure maternity coverage was covered, unlike before its passage. Before 2014, just nine states had legislation that required mandatory maternity coverage. A handful of plans offered the coverage or a special rider was needed and involved a waiting period. Many insurance companies are also deemed pregnancy as a pre-existing condition, allowing them to increase coverage prices on moms-to-be.
Before 2014, maternity coverage could be denied, making it tougher to pay for maternity-related costs. Now, health plans cover many maternity services:
- Outpatient services – doctors’ visits, lab studies, gestational diabetes screenings, prescriptions, etc.
- Inpatient services – doctors’ fees, hospitalization, surgery, etc.
- Lactation counseling and equipment
- Newborn care
Coverage is dependent on the plan chosen as they choose what benefits to cover. Out-of-pocket costs are affected by copayments, deductibles and providers.
How To Determine Covered Benefits
Health insurance companies much provide a Summary of Benefits and Coverage document, which is a summary that details what every plan offers to provide. Expectant or plan-to-be mothers should review the Summary to determine if their plan is right for them and compare each one to ensure they don’t get caught with unexpected medical bills.
According to the ACA, major medical plans can no longer deem pregnancy a pre-existing condition even if the pregnancy was before coverage started.
If you have a grandfathered individual health plan – not those offered by employers but attained on your own, they do not have to cover pregnancy and/or childbirth. Consider contacting your health insurance provider to find out what they do offer in terms of pregnancy and childbirth.