All Health Insurance Marketplace and Medicaid plans cover pregnancy and childbirth. This is true even if your pregnancy begins before your coverage takes effect.
IMPORTANT: Having a baby qualifies you for a Special Enrollment Period (SEP). This means that after you have your baby you can enroll in or change Marketplace coverage even if it’s outside the Open Enrollment Period. When you enroll in the new plan, your coverage can be effective from the day the baby was born.
Even during Open Enrollment, it may make sense to apply for coverage with an SEP. With most Marketplace coverage, if you enroll by the 15th of the month, coverage begins the first day of the next month. If you enroll with an SEP, coverage can begin the day the baby is born, even if you don’t enroll until up to 60 days after the birth.
Note: If you gave birth or adopted in the final months of 2016, you qualify for an SEP. This allows you to enroll in coverage for 2016, starting the day of the birth or adoption and ending December 31, 2016 — even if you enroll in the 2016 plan in 2017, up to 60 days after the event. To get coverage for a 2016 birth, contact the Marketplace Call Center.
If you already have Marketplace coverage when your baby is born, you can do one of 2 things:
Maternity care and childbirth are covered by Medicaid and Children’s Health Insurance Program (CHIP).
These state-based programs cover pregnant women and their children below certain income levels. Eligibility and benefits are different in each state. Income levels to qualify are different for Medicaid and CHIP.
You can apply for Medicaid or CHIP any time during the year, not just during Marketplace Open Enrollment. You can apply 2 ways: Directly through your state agency, or by filling out a Marketplace application. Learn how to apply for Medicaid and CHIP.
Many states have expanded their Medicaid programs to cover all people whose income is below certain levels. Even if you didn't qualify for coverage in the past, you may qualify now.
Whether you qualify for Medicaid depends on whether your state has expanded Medicaid coverage and your household size and income.
Learn if your state is expanding Medicaid and what this means for you.