Key takeaways
- Maternity is covered on virtually all plans
- But there are some exceptions
- Most employer-sponsored plans have covered maternity for decades
- All new individual major medical plans include maternity coverage
- Pregnancy no longer results in individual major medical application rejections
- In some states, pregnancy is a qualifying life event
Q. Do all health insurance plans cover maternity care?
A. Nearly all health plans cover maternity. Since January 2014, the Affordable Care Act (ACA) has required all newly issued and renewing individual and small-group health insurance policies to provide maternity coverage.
Large-group plans have long been required to include maternity coverage, thanks to the Pregnancy Discrimination Act of 1978, which applies to employers with 15 or more employees. In addition, 18 states had passed laws over the years that required smaller groups and/or individual policies to cover maternity benefits. Some states had tighter requirements even before the ACA, but the ACA closed the remaining gaps.
The ACA requires large employers (50 or more employees) to offer coverage to their full-time employees, and the longstanding Pregnancy Discrimination Act ensures that maternity care is part of the coverage.
The ACA also requires all individual and small-group plans to include maternity care as one of the law’s essential health benefits. Small employers (up to 49 employees) are not required to offer coverage, but if they do, it has to include maternity care. (Small employers can self-insure instead of purchasing small-group coverage, but they would still be subject to the Pregnancy Discrimination Act of 1978, assuming they have 15 or more employees.)
And anyone who doesn’t have access to coverage from an employer can purchase an individual-market plan instead, with coverage for maternity care included in all plans in every state. Maternity coverage must be covered on all non-grandfathered/grandmothered individual and small-group plans issued on or after January 1, 2014. So all of the policies being sold in the exchanges – and off-exchange – include maternity coverage. The ACA also prohibits gender-based premium determination, so women cannot be charged more for their policies than men.
Prior to 2014, the majority of individual health insurance policies did not cover maternity as a standard benefit. In some states, it was available as an optional rider, but the cost was often prohibitively high, since the coverage was usually only purchased by people who were planning to use it, and was priced accordingly.
Can my health insurance application be rejected because I'm pregnant?
No, pregnancy will not cause your application to be rejected, as long as you’re enrolling in an employer-sponsored group health plan or an ACA-compliant individual/family health plan. The ACA prohibits health plans from turning away applicants because of preexisting conditions, including pregnancy.
Prior to 2014, pregnant women (and expectant fathers) in most states could not obtain coverage in the individual/family market, even if the plan didn’t include any maternity benefits. The reason expectant fathers were denied coverage was that insurers were generally required to allow either parent to add a newborn baby to the parent’s existing health policy without any medical underwriting; allowing either parent to enroll during the pregnancy would open the insurer up to potentially having to cover a baby with serious health conditions from the first day of its life.
What health plans still don't cover maternity care?
Although maternity care is routinely covered on most health plans, there are still some plans that don’t cover maternity care. These include plans that pre-date the ACA, dependent coverage on large-group plans, and plans that aren’t regulated by the ACA at all.
If you’ve retained your grandmothered or grandfathered plan, your plan may not include maternity care.
In addition, large-group plans are not required to provide maternity coverage for dependent children, which has become more significant now that adult children can remain on their parents’ plans through age 26. The National Women’s Law Center filed a discrimination complaint about this in June 2013. In May 2015, HHS announced that plans must cover preventive care – including prenatal care – for dependents, but there is still no requirement that dependents be covered for labor and delivery costs.
And coverage that’s not regulated by the ACA, including “excepted benefits,” does not have to conform to any of the new rules. So if you purchase a short-term insurance policy, a fixed indemnity plan, travel insurance, or other supplemental coverage, it’s not likely to provide any maternity benefits.
Healthcare sharing ministries are also not regulated by the ACA (or state insurance departments, as they’re not technically considered insurance), so there’s no requirement that they provide maternity benefits. Some of these plans will allow members to share maternity costs, but there is often an exclusion for out-of-wedlock births, or for pregnancies that begin before the person joins the sharing ministry plan.
Farm Bureau plans are available in some states, and are not considered insurance.1 This means they’re exempt from state and federal insurance rules, so they do not have to cover maternity care or any other essential health benefit. Like other plans that aren’t regulated by the ACA, these plans can use medical underwriting to determine eligibility for coverage.
If you’re buying a plan that’s not regulated by the ACA, there’s a good chance that it won’t cover maternity, and it’s also likely that your application will be rejected if you’re already pregnant when you apply for coverage. Individual major medical plans that are grandfathered or grandmothered can no longer be sold to new applicants, but short-term plans, excepted benefits, health care sharing ministry plans, and Farm Bureau plans can still be sold to new applicants, and can reject applicants based on medical history. Pay attention to the fine print, and know that there are plans available in every state that do cover maternity care, although enrollment is limited to open enrollment periods and special enrollment periods, just the way it is for employer-sponsored plans.
Is pregnancy a qualifying event that will allow me to enroll in health coverage?
In most states, no. Some states — New York, Connecticut, Maine, Maryland, New Jersey, Rhode Island, Vermont, Colorado, and DC — provide a special enrollment period that begins when a pregnancy is confirmed by a medical provider. But in most states, the special enrollment period only begins when the baby is born, and not at the start of the pregnancy.
If you’re uninsured and pregnant, you’ll definitely want to check to see if you qualify for Medicaid or CHIP. The income limits for these programs are higher for pregnant women, and you’ll count as two people when you’re pregnant and applying for Medicaid/CHIP.2 The more people in the household, the higher the income limits, so this can help to make it easier to qualify for coverage. Medicaid/CHIP enrollment is available year-round.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- ”Information on Farm Bureau Health Plans, Health Care Sharing Ministries, and Fixed Indemnity Plans” Government Accountability Office. July 2023 ⤶
- ”Medicaid, Children’s Health Insurance Program, & Basic Health Program Eligibility Levels” Centers for Medicare & Medicaid Services. December 2023. ⤶
Get your free quote now through licensed agency partners!