Health Insurance Coverage for Pregnant and Postpartum Individuals
During pregnancy, individuals often visit a doctor at least 21 times during the nine months before the birth of their baby to check on growth and development, and to screen for issues. This can be a lot to manage.
However, health care services provided during and after pregnancy are considered essential health benefits. This means health plans must provide coverage for these services. “Coverage” means a health plan will pay for a portion of the bill for services; and in many cases, the health plan pays a significant part of it.
Health insurance is a critical component to preparing for the birth of a child. It provides access to prenatal care, which can help prevent complications during pregnancy. And once the child is born, health insurance can help cover the cost of any unexpected issues that may arise, as well as access to and coverage for checkups for mothers and newborns. Pregnant individuals without insurance may be able to get coverage through Medicaid or the Marketplace. Visit healthcare.gov to learn more.
Tips for individuals with health insurance:
- Check health plans to understand coverage details for prenatal and postnatal care
- After giving birth, individuals should report the birth to their health plan to enroll their child as soon as possible
- Individuals on Medicaid when they give birth will have their newborns automatically enrolled in Medicaid
Tips for individuals without health insurance:
- Visit healthcare.gov to check qualifications for a Marketplace or Medicaid plan
- Individuals who recently gave birth can enroll in a new health insurance plan on the Marketplace, including Medicaid, as they qualify for a special enrollment period within 60 days of giving birth
Prenatal and Postnatal Care
Preventive care provided at prenatal and postnatal appointments is essential to ensuring a healthy pregnancy and a healthy life for mother and child. Some family physicians may offer prenatal and postnatal care; however, OB-GYNs specialize in this field, and many pregnant individuals prefer their experience and range of services. Here are some common services covered by health insurance plans:
- Prenatal care
- Labor and birth services
- Prenatal vitamins
- Screening tests
- Wellness checkups
- Postnatal care
- Wellness checkups for mother and child
- Breastfeeding support
Lactation Supplies and Support
Most health plans are required to help individuals breastfeed their children by covering support, counseling and equipment.
Namely, breast pumps are covered by insurance. Individuals should check with their insurance plan to understand the guidelines on what is available. Pumps may be new or rented; and may need signoff from the individual’s doctor before they are available. Mothers should discuss whether breastfeeding is right for them with their doctor to see if there are any medical concerns.
Schedule of Prenatal Visits
Health care providers recommend a schedule of appointments for mothers during and after their pregnancies to ensure the baby is growing and the mother remains healthy. However, if there are complications or certain risk factors, providers may recommend more frequent visits. Health insurance plans are required to cover the cost of these visits.
Here’s the traditional appointment schedule for mothers:
- Weeks four to 28 of pregnancy: One checkup each month
- Weeks 28 to 36 of pregnancy: Two checkups each month
- Weeks 36 to 41 of pregnancy: One checkup each week
- Six weeks after delivering baby: One checkup
There are urgent maternal warning signs that can occur during pregnancy or in the first year after delivery that should prompt an immediate trip to the doctor, including dizziness; vaginal bleeding or leaking; extreme swelling of the face, hands, legs or arms; vision changes; chest pain or rapid heart rate; difficulty breathing and fever of 100.4 degrees F or higher.
Schedule of Well-Child Visits
A separate schedule of appointments with a pediatrician is also recommended for babies following birth to ensure the first weeks and months of their lives are progressing appropriately and that any early warning signs of health issues are addressed quickly. Health plans are required to cover the costs of these visits. Here’s the traditional well-child appointment schedule for infants during their first year:
- The first week (three to five days old)
- 1 month old
- 2 months old
- 4 months old
- 6 months old
- 9 months old
- 12 months old
Between ages one and two, toddlers are seen every three months by their doctor. They see the doctor again at age 2.5 and three, after which they see the doctor once a year.
Denice Logan, D.O., is a medical director at Blue Cross Blue Shield of Michigan. For more health tips and information, visit MIBluesPerspectives.com.
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