Maternity care coverage under Obamacare (Patient Protection and Affordable Care Act) boosted access and lowered premium costs to needed benefits for many expectant women and their offspring.
However, many holes remain. Just because you read glowing reports from certain media outlets about the new law, does not mean that you can assume that the federal government will take care of every mother-to-be.
Be prepared for waiting periods, premium costs, lack of paid leave, issues surrounding pregnancy as a preexisting condition, and dependent teenage pregnancies. Read a brief summary, and follow links for further information.
Obamacare Maternity Care Benefits
Obamacare maternity care benefits consist of required coverage for prenatal care, mom’s hospitalization for labor and delivery, a possible stay in Neonatal Intensive Care (NICU) for thirty days for a preterm infant, along with newborn care.
These important features are part of the required minimum essential health benefits that each plan must provide. Get a feel for your projected health insurance premiums, and the implications of waiting periods. However, do not expect the new law to address paid maternity leave.
Health Insurance Premiums
Your monthly health insurance premium costs for maternity coverage under Obamacare may be lower than you think. In the individual marketplace, government subsidies may dramatically lower expenses for select lower-income families.
The law requires that employers with more than 50 employees offer a qualifying program that consumes no more than 9.5% of your gross monthly income. This means that your employer may need to make a significant contribution towards your premium. You pay the remainder using pre-tax payroll deductions, which lower the amount of FICA, and income taxes you pay.
The maternity coverage waiting period under Obamacare is a frequently misunderstood topic. The law does require that carriers pay for preexisting health conditions with no waiting period after the policy effective date. This part is true.
You can buy health insurance when already pregnant, but it is not as simple as it sounds on the surface. Both individual and employer groups have rules dictating specific times when you can and cannot start a new policy. Do not wait until after conception to make this important enrollment choice, otherwise, you may find yourself locked out of an important program.
Paid Maternity Leave
Paid maternity leave works no differently under Obamacare than it did before passage of the new law. The regulation is silent regarding income replacement during the time mom is unable to work because of complications, or while she recuperates from childbirth.
Supplemental maternity insurance provides a private solution to the paid maternity leave problem in the USA. You must purchase these policies prior to conception. Only programs offered through employers groups as voluntary benefits pay for normal childbirth.
Affordable Care Act Pregnancy Coverage
The Patient Protection and Affordable Care Act (PPACA) requires coverage for pregnancy, which includes prenatal care, hospitalization for labor and delivery, as well as newborn care. Carriers can no longer treat pregnancy as a preexisting condition to exclude benefits.
However, this does not mean that every expectant woman will find a plan meeting her needs. The pre-existing condition regulation has loopholes, which may apply differently based upon due date, income, and whether teenage dependents are included in your group plan.
Pregnancy Preexisting Conditions
The Affordable Care Act makes it unlawful for a carrier to treat pregnancy as a pre-existing health condition. The carrier cannot deny your application for coverage simply because you are already expecting. Benefits become payable immediately after the policy effective date.
Open enrollment period rules mean that you cannot buy or switch policies any time you please. Unless you experience a qualifying life event, you must wait until January 1 of each year for a new individual plan to begin. Employer groups set their own timetables for plan effective dates.
Dependent and Teenage Pregnancies
Dependent and teenage pregnancies reveal a giant loophole. Under the Pregnancy Discrimination Act, group health care plans must cover prenatal care and related services. However, this requirement does not extend to dependents.
Under the Affordable Care Act, group plans must cover prenatal care for dependent pregnancies. However, this does not extend to the far more expensive hospitalization for labor and delivery.
Approximately 70% of group health insurance plans do not cover dependent pregnancies. This means that if a family enrolls in an employer-sponsored plan, their teenage daughter may find herself without vital monetary support if she conceives.
She may be able to take advantage of Medicaid. Pregnant teenagers may qualify in some states, even if household income of the parents exceeds guidelines. Other states may work differently.
Pregnancy Assistance Fund
The Affordable Care Act Pregnancy Assistance Fund is a competitive grant program providing financial aid to states and tribal entities to support access the healthcare, childcare, housing, and other needs for expectant women and new mothers.
You cannot tap into these resources directly. You can take advantage if an agency in your state received the funding.