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How To Baby-Proof Your Health Insurance Checklist

Having a Baby? Here are 6 Things to Prep Your Coverage.

Written by: Aaron Garcia.

Key Takeaways

  • Health insurance may cover some or all maternal and paternal services, but the amount is not standard across all policies.

  • Having a child qualifies you for a Special Enrollment PeriodThe Special Enrollment Period is a 60-day period outside the Open Enrollment Period when you can enroll or change your coverage. Special Enrollment Periods are only granted if you experience a Qualifying Life Event. These are special circumstances that may change your health insurance needs., where you can enroll in a new plan for 60 days after your child is born.

  • Several factors cause more out-of-pocket costs during your pregnancy. You should review your coverage and costs with your carrier or provider.

Close up of father holding newborn baby's feet.

Welcoming a new child is always exciting, but it also means there’s work to be done. Getting ready before they arrive can mean the difference between settling in or losing sleep (OK, that’ll probably happen either way).

The same goes for your health insurance. Here’s an easy checklist to baby-proof your coverage and help you sleep easy–while you still can.

1. Know What's Covered

As an expecting mother, there are many services available to you — some even with no out-of-pocket cost. All health insurance plans must cover maternal [1] and newborn [2] care. The ACAThe Affordable Care Act is a healthcare reform bill from 2010 aimed at reducing the amount of uninsured Americans by making coverage more affordable. Also known as The Patient Protection and Affordable Care Act, the ACA requires insurance companies to cover preventive care and other essential health benefits. Also known as "Obamacare." includes services before and after birth. Covered services include:

Covered Services under the ACA

Gestational diabetes screeningsImmunizations
Preeclampsia preventionChildbirth
Folic acid supplementsBlood screening
Breast pumpsHearing screening
Breastfeeding consultationsHypothyroidism screening
and many moreand many more

2. Choose your OB-GYN Carefully

Always make sure your OB-GYN is in your health insurance company’s provider network. Also, check that your insurance covers the hospital your OB-GYN uses for deliveries. You can be stuck with the entire bill if you deliver at a hospital that isn’t in your network.

3. Tell Your Insurance Company the Good News

Let your insurance company know you’re having a baby, and review your benefits so you take advantage of what is available to you. You may be unaware of available options in your policy. For example, your plan may let you use a midwife for your child’s birth. Your health insurance company can confirm that your doctors and delivery site are in-network. They’ll be your go-to source for info about how your pregnancy is covered. And getting the most out of your policy means receiving invaluable prenatal and maternal care.

4. Figure Out Your Out-of-Pocket Costs

While many maternity services are covered, don’t assume everything is. Review which services you’ll need to pay out of your pocket. Know how much you need to spend to meet your deductible and begin cost-sharing. Know what you’ll be required to pay, including:

5. Keep Up With Your Prenatal Care

Staying on top of your prenatal health will help you and your baby stay healthy during pregnancy. All health insurance policies cover a list of services you can receive at no cost. Folic acid supplements, fetal heartbeat monitoring, and specific blood tests are all examples of covered maternal and prenatal services.

6. Reevaluate Your Health Insurance Plan Options Following the Birth

Having a baby is a Qualifying Life Event (QLE)Qualifying Life Events (QLE) are life changes that allow you to enroll in a new health insurance plan during a Special Enrollment Period. These include having or adopting a child, losing other coverage, marriage, a change of income and moving. that makes you eligible for a Special Enrollment Period. Your QLE enrollment window starts when your baby is born and remains open for 60 days. If you think you’ll be seeing the doctor more often with a young one, you might consider a plan with the lower deductible and out-of-pocket maximum.


Can you be denied health insurance if you’re pregnant?

No. After the ACA, health insurance companies aren’t allowed to deny coverage for any pre-existing condition, including pregnancy. You can purchase coverage and receive maternity benefits even if you’re pregnant during the annual Open Enrollment Period.

How much does it cost to have a baby with health insurance?

Recent studies show that even with insurance, the out-of-pocket costs of having a baby can average around $5,000. [3] Those amounts go up depending on the nature of your pregnancy and delivery.

What if I don’t have health insurance when I’m pregnant?

Depending on your state, you may be able to sign up for health insurance. If not, you may have community health centers or family planning clinics that can help. Give GoHealth a call, and one of our licensed insurance agents will discuss your options.

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