Under the federal law maternity care is covered but states reserve the right to decide on the services included. With the Affordable Care Act, pregnant women have more health options than ever before.
"The fact that the Affordable Care Act requires qualified health plans to cover maternity care and offers financial assistance to reduce out-of-pocket costs is a game changer for many women," says Lauren Birchfield Kennedy, director of health policy at the National Partnership for Women and Families, a nonprofit in the District of Columbia. "It's probably the greatest advance in women's health in a generation."
Karen Davenport, director of health policy at the National Women's Law Center, says the federal law has given "women lots more flexibility in terms of their work lives and health insurance decisions because they know they can purchase coverage on their own and have all [maternity-related] services covered."
In some states, women could not get insurance because pregnancy was considered a pre-existing condition. "Women now have the peace of mind of knowing they cannot be denied coverage because of a pre-existing condition," she says.
When you're uninsured, you may qualify to receive discounted coverage if you buy a plan in the state and federally operated marketplaces (like HealthCare.gov) created by the law. These marketplaces offer tax credits for premiums and subsidies for out-of-pocket expenses, depending on your income and household size.
Enrollments in the government marketplaces run until Feb. 15, 2015. But if you miss this deadline, you'll need to wait until next year to get coverage. "We encourage anyone who is pregnant or who thinks they may become pregnant to visit the marketplace now to make sure they have coverage for the duration of their pregnancy," Kennedy says.
Study your plans carefully; as when you have coverage from the state and federal marketplace, you may be eligible for a larger tax credit, where subsidies based on income and the size of a household with the addition of a baby may have bigger savings. The marketplace should be informed about these changes.
When you adopt a child you can buy or change an insurance policy during a special enrollment period, you have 60 days to enroll after your child's birth. You don't qualify for special enrollment if you are pregnant, "You qualify for a special enrollment once the baby is born," Davenport says.
Pregnant women with lower and moderate incomes may qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program, depending on where they live. Women can enroll in Medicaid or CHIP at any time.
By law, states must offer Medicaid coverage to pregnant women with incomes at or below 133 percent of the federal poverty level ($15,560 for an individual or $31,800 for a family of four), although some states cover pregnant women with incomes of 185 percent of poverty. Medicaid also must cover pregnancy-related services without cost sharing.
All marketplace and employer-based plans must cover breast-feeding services and supplies without any cost-sharing expenses to women. This includes coverage for consultations with a lactation expert, breast pumps and more.
This benefit is "new for breast-feeding moms and insurance companies, so there are definitely some coverage kinks that over time will get worked out," Davenport says. The National Women's Law Center has a toolkit on its website to help breast-feeding moms understand their rights and appeal decisions if a plan denies coverage.
Source: Magaly Olivero