Maternity coverage varies by plan, and you need to understand what your insurance actually pays for before you're pregnant

Maternity coverage is not automatic in all health insurance plans, and the costs you'll pay depend heavily on which plan you choose and when you enroll. Some plans cover prenatal care, delivery, and postpartum visits with low or no copays. Others require you to meet a deductible first, or they exclude maternity altogether. If you're thinking about pregnancy, the time to check your coverage is now — not when you find out you're pregnant.

The Affordable Care Act requires most health insurance plans to cover maternity and newborn care, but that rule has exceptions. Short-term plans, some religious-based plans, and plans sold before the ACA took effect may not include maternity benefits. If you're uninsured or your plan doesn't cover maternity, you have options: you can enroll in a marketplace plan during open enrollment or a may have access to life event, or you can look into Medicaid, which covers maternity for most people who meet income limits.

Key Takeaways

  • Most ACA-compliant plans cover prenatal visits, delivery, and postpartum care, but you should verify this in your plan documents before you become pregnant.
  • You will likely pay a deductible before maternity coverage kicks in, and costs vary widely depending on whether you choose an HMO, PPO, or high-deductible plan.
  • If you're uninsured or your plan excludes maternity, you can enroll in a marketplace plan outside the normal open enrollment window if pregnancy is a may have access to life event.
  • Medicaid covers maternity care for most people below certain income thresholds, and some states have expanded coverage to include postpartum care for up to a year after delivery.
  • Your out-of-pocket costs for delivery can range from nothing to several thousand dollars depending on your deductible, coinsurance, and whether you use in-network providers.

What maternity coverage actually includes

Maternity coverage under the ACA includes prenatal care (doctor visits and screenings), delivery and hospital stays, postpartum care for you, and newborn care for your baby. Prenatal care typically includes routine visits, ultrasounds, and lab work. Delivery covers the hospital or birth center stay, the provider's fees, and anesthesia if you need it. Postpartum care covers follow-up visits after you leave the hospital, usually for six weeks.

What maternity coverage does not always include: fertility treatments, surrogacy, abortion (varies by state and plan), or elective procedures like circumcision. Some plans also exclude or limit coverage for complications that arise during pregnancy, though most ACA plans do cover them. Check your plan's summary of benefits and coverage (often called the SBC) to see exactly what's in and what's out.

Newborn care is covered for the first 30 days of life in most plans, which includes hospital stays, screening tests, and vaccinations. After 30 days, your baby needs to be added to your insurance plan, usually within 30 days of birth, or they lose coverage. If you don't add your baby, you'll pay out of pocket for all care.

How much you'll pay out of pocket

Your out-of-pocket costs depend on your plan type and whether you've met your deductible. If you have a plan with a $1,500 deductible, you pay that amount before the plan starts sharing costs with you. Prenatal visits might be covered at 100% before you meet your deductible (many plans do this), or you might pay a copay for each visit. Once you meet your deductible, you typically pay coinsurance — usually 10% to 20% of the cost — for the rest of your care.

Delivery is the biggest expense. A vaginal delivery without complications costs hospitals between $5,000 and $15,000 on average, though prices vary widely by region and hospital. A cesarean section costs more, typically $10,000 to $25,000. If you have insurance, you don't pay the full amount — the insurance company negotiates a lower rate with the hospital. But you still pay your share: your deductible plus coinsurance on the negotiated price.

Example: You have a $2,000 deductible and 20% coinsurance. Your hospital charges $12,000 for a vaginal delivery. The insurance company's negotiated rate is $8,000. You pay $2,000 (your deductible) plus 20% of the remaining $6,000 ($1,200), for a total of $3,200 out of pocket. The insurance company pays $4,800.

If you use an out-of-network provider, your costs are usually much higher. Out-of-network deductibles and coinsurance percentages are often higher than in-network rates. Before you choose a hospital or midwife, call your insurance company to confirm they're in-network.

Plan types and what they mean for maternity costs

HMO plans typically have lower premiums and lower out-of-pocket costs for maternity care, but you must use in-network providers and get referrals for specialists. If you see an out-of-network provider without a referral, the plan won't pay. PPO plans cost more in premiums but let you see any provider without a referral, and out-of-network costs are usually covered at a higher percentage than in an HMO. High-deductible plans (often paired with a Health Savings Account) have the lowest premiums but the highest deductibles — sometimes $3,000 or more — so you pay more upfront for maternity care.

Catastrophic plans are the cheapest option if you're young and healthy, but they have very high deductibles and cover almost nothing until you meet it. Maternity care is an exception: catastrophic plans must cover three prenatal visits and delivery at no cost to you. However, if complications arise, you pay your full deductible before the plan kicks in.

The plan type that makes sense for you depends on whether you're planning pregnancy soon, your income, and how much you can afford to pay upfront. If you're planning to get pregnant within the next year, a PPO or HMO with a lower deductible usually saves you money overall, even if the premium is higher.

Medicaid and maternity coverage

Medicaid covers maternity care for people who meet income and citizenship requirements. Income limits vary by state, but most states cover pregnant people with incomes up to 138% to 200% of the federal poverty line. In 2024, that's roughly $20,000 to $29,000 per year for a single person, though it's higher for families. You can apply for Medicaid at any time if you're pregnant — you don't have to wait for open enrollment.

Medicaid covers all prenatal care, delivery, and postpartum visits with no copays or deductibles. It also covers complications of pregnancy and childbirth. Some states have expanded Medicaid to cover postpartum care for a full year after delivery, not just the traditional six weeks. If you think you might be may be able to access, apply through your state's Medicaid office or at healthcare.gov.

If you're already on Medicaid and become pregnant, you stay covered. If you lose Medicaid after delivery, you can usually stay on it for 60 days postpartum in most states, though some states have extended this to a year. Ask your state Medicaid office about the timeline in your state.

Enrolling in coverage if you're uninsured

If you don't have health insurance and you're not pregnant yet, you can enroll in a marketplace plan during the annual open enrollment period, which usually runs from November through January. If you're already pregnant and uninsured, pregnancy is a may have access to life event, which means you can enroll in a marketplace plan outside of open enrollment. You'll need to provide proof of pregnancy, usually a letter from your doctor or a positive pregnancy test.

When you enroll, you'll see plans at different metal levels: Bronze, Silver, Gold, and Platinum. Bronze plans have the lowest premiums but the highest deductibles. Platinum plans have the highest premiums but the lowest deductibles and out-of-pocket costs. For maternity care, a Silver or Gold plan usually offers the best balance of premium cost and out-of-pocket expenses.

You may also be may be able to access for subsidies (tax credits) that lower your premium, or cost-sharing reductions that lower your deductible and coinsurance. These are based on your income. If you're pregnant and your income is low, you might may have access to for both a subsidy and Medicaid, depending on your state.

What happens if your plan doesn't cover maternity

If you have a plan that doesn't include maternity coverage — such as a short-term plan, a plan grandfathered under the ACA, or a plan sold outside the marketplace — you have options. You can wait until the next open enrollment period and switch to a plan that covers maternity. Or, if you're pregnant now, you can enroll in a marketplace plan immediately using pregnancy as a may have access to life event.

If you can't or don't want to switch plans, you'll pay for maternity care out of pocket. Some hospitals and birth centers offer payment plans or discounts for uninsured patients. Federally may have access to health centers (FQHCs) also provide prenatal and delivery care on a sliding fee scale based on your income. You can find an FQHC near you at findahealthcenter.hrsa.gov.

Planning ahead: what to do before you get pregnant

If you're thinking about pregnancy, review your current health insurance plan now. Look at your deductible, coinsurance percentage, and whether maternity is covered. If your plan doesn't cover maternity or has a very high deductible, you can switch to a different plan during open enrollment. If you're uninsured, enroll in a marketplace plan before you get pregnant so you don't have to rush during a may have access to life event.

Once you're enrolled in a plan with maternity coverage, ask your insurance company for a list of in-network obstetricians, midwives, and hospitals. Call the hospitals to confirm they're in-network and ask what your out-of-pocket costs will be for delivery. Some hospitals can give you an estimate based on your plan. If you're planning to use a midwife or birth center, confirm they're in-network and that the insurance company will cover the birth facility.

If you're on Medicaid, you don't need to do much planning — your coverage is automatic once you're approved. But do ask your Medicaid office which providers are in-network and whether your state covers postpartum care beyond six weeks.

Frequently Asked Questions

Can I enroll in a marketplace plan if I'm already pregnant?

Yes. Pregnancy is a may have access to life event, so you can enroll outside of open enrollment. You'll need to provide proof of pregnancy, usually a letter from your doctor or a positive pregnancy test result. Contact healthcare.gov or your state's marketplace to start the process.

What if I'm pregnant and my employer plan doesn't cover maternity?

This is rare under the ACA, but if it happens, you can switch to a marketplace plan using pregnancy as a may have access to life event. You have 60 days from the date you become pregnant to enroll. You can also check whether you're may be able to access for Medicaid, which covers maternity regardless of your employer coverage.

Do I have to pay for prenatal visits before I meet my deductible?

Most plans cover routine prenatal visits at 100% before you meet your deductible, but some don't. Check your plan's summary of benefits and coverage or call your insurance company to ask. If prenatal visits are subject to your deductible, you'll pay out of pocket until you reach it.

What happens to my insurance coverage after the baby is born?

Your coverage continues as normal. Your newborn is automatically covered for the first 30 days. After that, you must add your baby to your insurance plan, usually within 30 days of birth. This is considered a may have access to life event, so you can add your baby even outside of open enrollment. If you don't add your baby, they lose coverage after 30 days.

How do I know if a hospital or doctor is in-network?

Call your insurance company's customer service number (on your insurance card) and ask for a list of in-network maternity providers and hospitals in your area. You can also search online using your insurance company's provider directory. Always confirm in-network status before scheduling care, because out-of-network costs are much higher.