Four Important Details About Insurance Plans for Pregnancy

If you have health insurance, the medical services provided during pregnancy and delivery are considered essential health benefits. This means all qualified health plans must cover these services without requiring copays or coinsurance, even if you haven’t met your deductible. But what does that mean for you? If you're pregnant or hoping to become pregnant, here are four things you’ll want to be sure you understand about health insurance plans and coverage during pregnancy.

1. Out-of-Pocket Costs

Because care during pregnancy is an essential health benefit, health insurance plans cover visits related to your pregnancy. So you should not have any out-of-pocket costs for regular check-ups with your care provider – unless you choose extra, or nonessential, services.

One example of an extra or nonessential service might be a special ultrasound. Most plans provide coverage for standard 2-dimensional (2D) ultrasounds, or sonograms, because these provide medically necessary information about a baby’s health. But if you want a more clear 3D ultrasound, you’ll likely have to pay for this extra service yourself.

Coverage could vary depending on your plan and whether your provider is in your plan’s network, so be sure to check with your insurer to get all the details about out-of-pocket costs during pregnancy.

2. Screenings and Tests

There are many types of routine lab tests and screenings that are required throughout pregnancy. These tests help care providers monitor the health of both you and your baby.

Both urine and blood are commonly tested multiple times during pregnancy to:

• Check if you have any infections
• Determine blood type and Rh factor
• Screen for certain birth defects
• Monitor your health for conditions that may arise during pregnancy, such as gestational diabetes

You’ll also have at least one ultrasound. This test gives a visual image of the baby, so doctors can see how the baby is growing.

Some tests and screenings will be conducted several times while others only need to be done once. And testing needs may vary depending on your health, age, and other factors.

Required tests are typically covered without a copay or coinsurance, but for full coverage, testing may need to be performed by labs and providers within your plan’s network.

3. Plan Network

A plan network is the group of facilities, providers, and suppliers your health plan has contracted with to provide services. For best coverage of costs related to your pregnancy, you’ll probably need to get your care from providers that are part of your plan’s network. This information should be available on your insurer’s website, or you can call the number on your member ID card.

If you are shopping for insurance and already have a care provider, be sure to check the plan’s network to see if your provider is included.

4. Not a Qualifying Life Event

If you already have health insurance, your plan will help cover your healthcare services. But if you don’t currently have health insurance, you can enroll during open enrollment or when you have a qualifying life event.

Pregnancy is not considered a qualifying life event. So, if you are pregnant, or there’s a chance you might become pregnant, you’ll want to sign up for an insurance plan during the annual open enrollment period.

The baby’s birth, however, is considered a qualifying life event and will open a special enrollment period. So if you weren’t able to get insurance before your child’s birth, you will have a chance to get coverage after the birth.

Questions About Health Insurance Coverage for Pregnancy