Q: Now that the ACA has been implemented, do all health insurance plans cover maternity?
A: In most cases, the answer is yes. Since January 2014, the 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 passed laws over the years that required smaller groups and/or individual policies to cover maternity benefits.
But 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.
Maternity coverage is one of the essential health benefits that must be covered on all non-grandfathered/grandmothered individual and small group plans that are issued or renewed 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.
There are a few exceptions to keep in mind. If you’ve retaining your existing individual policy (possible until September 2017 in many states) or if you’re staying on a grandfathered plan, you won’t have maternity coverage unless it’s already included on your plan.
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 travel insurance, short-term insurance, discount plans, and various supplemental plans, does not have to conform to any of the new rules. So if you purchase a short-term insurance policy, it’s not likely to provide any maternity benefits.