Health Insurance With Maternity Coverage

Maternity Health Insurance 101

Coverage basics if you are pregnant or planning to become pregnant, including questions to ask and options to explore

Discovering that you are pregnant can be one of the most exciting moments of your life. From the instant you see that positive pregnancy test, your mind may start to race with thoughts of lifestyle changes, nursery designs, names for the little one, and your new role as a parent. You probably won't immediately think about one of the most important aspects of the next nine months; health insurance. Prenatal care is crucial when considering your baby's health, as well as your own. Health insurance will also play a large part after your baby arrives, considering postpartum care and pediatric expenses. Whether you have an insurance plan or not, there are several important issues that need to be addressed as soon as possible.

If you currently have a health insurance plan, it's important to contact your provider to ask some critical questions. You don't want to be surprised with unexpected medical bills, so be sure to ask the necessary questions. For example:

  • Does your current health plan cover maternity care? If you have insurance through work, any employer with 15 or more employees is required by federal law to offer coverage for pregnancy related medical bills.
  • What are the rules for using an in-network versus an out-of-network provider? What about hospitals? If the benefits are greater for in-network participants, be sure to ask for a directory of those in your area.
  • What are the allowances for prenatal tests, such as ultrasounds, bloodwork, and amniocentesis procedures?
  • How long of a hospital stay is covered after delivery? Does your plan cover an extended stay if medically necessary?
  • If you're interested in using a certified nurse midwife or having your baby at a birthing center or at home, be sure to ask what your plan covers in these situations.

The questions should not be limited to your care. There will be medical expenses associated with your baby once he or she arrives. For some, a complicated delivery may lead to a visit to the neonatal intensive care unit, which is often accompanied by very large medical bills. You will want to know the answers to these questions before your baby is born.

  • What is the process for adding your new family member to your existing plan?
  • Will your plan cover your baby's hospital stay? Your newborn's medical expenses are separate from your own, and most insurance plans allow coverage only if you enroll your child for dependent benefits within 30 days of delivery.
  • If medically necessary, will your plan cover a stay in the neonatal intensive care unit?
  • What is the plan's allowance for in-network versus out-of-network pediatricians? If in-network providers are preferred, request a list of those participants in your area.
  • Will your plan cover well-child care? This includes routine pediatrician visits and vaccinations.

If you are one of the 41 million Americans without health insurance, you may feel a bit overwhelmed. The average cost of delivery is $6,000-$8,000 for a normal pregnancy, with the price increasing significantly for high-risk situations. Unfortunately, most major insurance providers consider pregnancy to be a pre-existing condition and therefore will not cover the medical expenses. However, if you are in the 13 percent of women who find themselves pregnant without health insurance, there are options available to you.


Medicaid is a federal health insurance program designed for low income families who do not have medical insurance. All states offer Medicaid or a similar program. There are general guidelines for eligibility that are established by the Federal Government; however each state has their own specific criteria. There are several requirements that may qualify you for this program. If you are pregnant and your income level is at or below 133 percent of the Federal Poverty level, then you will qualify. You can check with your local Medicaid office to find out what this number is in your area. If your income is above this level, you may still qualify medically. Contact your local Medicaid office to find out what documentation they require to determine your eligibility.

Most offices require proof of pregnancy, proof of citizenship, and proof of income. If eligible, you will receive a list of medical providers in your area who accept Medicaid, and as long as you receive care from an approved provider, all care related to the pregnancy, delivery, and any complications will be covered. Pregnant women are often given priority in determining Medicaid eligibility, due to the extreme importance of prenatal care. You can find more information, including contact information for your local Medicaid office, on the Medicaid website, Your state may also offer other programs to further assist you. Contact your local department of health for more information.


The federal agency known as WIC is another resource that may be available to you. Their mission is to protect the health of low-income women, infants, and children under the age of 5. They provide nutritious foods, information on healthy eating, and referrals to health care; all crucial elements of prenatal care. You can get more information at

Healthcare Discount Programs

An alternative to traditional health insurance plans and Medicaid, healthcare discount programs are designed to offer discount health care to those who need it. AmeriPlan is an example of such a program, and it is available in every state, with the exception of Alaska. They are a Discount Medical Plan Organization, or DMPO, with a mission to provide high quality, affordable medical care to all American families. They are not an insurance company, so they do cover pre-existing conditions. They also require no deductible, no waiting periods, no claim forms, and no annual limits. For more information, visit their website at or call them toll free at (800) 647-8421.

Other Suggestions

Many people are unaware that most hospitals are willing to set up a payment plan for services rendered. They frequently offer a sliding scale for charges as well. Contact the accounting department at the hospital in which you plan to deliver, and discuss these options with them. Delivering your baby at a birthing center is also an option, if you are having a normal, low-risk pregnancy. Birthing centers are typically staffed by midwives who are available to assist you in the delivery of your baby in a home-like setting.
If complications arise during delivery, you would need to be transferred to a nearby hospital, as these specialized centers are not equipped to handle these situations. The stay after delivery is often shortened too, with some mothers taking their babies home only hours after delivering. You may be able to save up to 50 percent of the normal delivery cost by opting for this plan.

Obtaining health insurance is easiest before you become pregnant, so if you're considering conceiving, securing coverage should be one of your first steps. However, if you find that you are pregnant without health insurance, remember that prenatal care is absolutely crucial for the well-being of both you and your baby. Explore your options, and take advantage of the available programs to ensure a safe and healthy pregnancy, delivery, and postnatal care plan.