Health coverage if you're pregnant or plan to get pregnant
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.
Learn more about Special Enrollment Periods and how to apply.
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.
If you already had Marketplace coverage, you can do one of 2 things when your baby is born:
- Keep your current plan and add your child to your coverage
- Change to a different Marketplace plan
Private health plans and pregnancy
- Maternity care and childbirth — services provided before and after your child is born — are essential health benefits. This means all qualified health plans inside and outside the Marketplace must cover them.
- You get this coverage even if you were pregnant before your coverage starts. Under the health care law pre-existing conditions are covered, including pregnancy.
- Health plans sold inside and outside the Marketplace must provide a Summary of Benefits and Coverage document. Page 7 of the summary spells out how the plan covers the costs of having a baby. You’ll see a link to a summary when you compare plan details in the Marketplace.
- Some grandfathered individual health plans — the kind you buy yourself, not the kind you get through a job — aren’t required to cover pregnancy and childbirth. If you have a grandfathered individual plan, contact your insurance company to learn about your pregnancy and childbirth coverage.
Maternity and childbirth under Medicaid and CHIP
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.
More people qualify for Medicaid
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.