Calling all new parents! Before we get started, we first want to say congrats! Expecting a new baby is exciting (and probably a little scary). While you are busy preparing everything else for your new baby, we prepped a quick, informative guide on health insurance for you! We know time is of the essence so we kept it short, but if you have any other questions, please leave us a comment, send us a message, or hit us up on Instagram or Facebook! Now, let’s get to it, shall we?
1. Your baby is covered under your plan during the first 30 days of life.
Now exhale. Having a new baby is challenging enough without the immediate hassle of figuring out insurance. Your baby should be automatically covered under your insurance plan for the first 30 days after giving birth!
Note: If you are still on your parent’s plan, this may not hold true. Call the insurance company and their HR in advance to determine eligibility.
2. Having a baby is considered a Qualifying Life Event, meaning you can add them to your existing insurance plan or change to a different insurance plan.
As you approach the 30 day mark, you’ll need to think about officially adding your baby to your health insurance plan. Having a baby is considered a qualifying life event, which means you qualify for a special enrollment (outside of the normal open enrollment) period for your health insurance plan. This change can be as simple as adding your baby to your current plan, or changing plans entirely.
To add your baby to your existing plan, gather the baby’s birth certificate and social security card. Then contact your company’s HR, your insurance broker, or a healthcare.gov advisor if you are on a marketplace plan.
3. Savvy Healthcare Hustlers may consider changing insurance plans after the addition of a child.
Simply continuing with your existing plan might not make sense with the addition of a baby. Babies often change your overall expected healthcare utilization, as you are likely to see a doctor at least once or twice during the year. When your healthcare utilization changes, you should examine the health plans available to you to determine which is the best fit.
There are two ways to save money when you are shopping around for an insurance plan:
Reduce your monthly premiums
The difference in premiums between a plan for “You” or “You + Spouse” to “Family” may be substantial.
Employers often subsidize the cost of the employee’s monthly premiums, but rarely chip in for additional family members.
Compare the cost of monthly premiums on each plan available to you instead of blindly sticking with your old plan.
Maximize your benefits for your expected healthcare utilization
If you anticipate having several new doctor visits and minor procedures, you might change from an HDHP to a PPO plan.
If you anticipate several major upcoming surgeries or procedures, you may consider switching to the plan with the lowest total cost of out-of-pocket maximum + premiums to minimize your overall costs.
4. Read your EOBs carefully AFTER having a baby. Also, if you’ve never called your insurance company, now is the time.
Billing when there is a new baby can be extremely confusing as there are multiple providers, some care is billed under the mom while other care can be billed under the baby, and the baby’s coverage can be retroactive. Below are some general guidelines for the bills you’ll see and how to double check them for accuracy.
You will likely get separate bills from the hospital, the OBGYN, and possibly the anesthesiologist, and lab providers.
Most services will be billed under the mom, but some services can be billed to the baby. This is most common if the baby required any of their own services or procedures due to complications.
As soon as you get any medical bill related to labor and delivery, call your insurance company representative at the number on the back of the insurance card and have them walk you through the respective Explanation of Benefits (EOB) line-by-line. The “patient responsibility” on the EOB and the bill should match. If they do not, ask follow up questions until you have a clear idea of what is going on and what to do about it.
If specific services are denied, ask the hospital to drop the charge for that service. If they don’t, go back to your insurance company to file an appeal, especially if they are in-network providers.
If your in-network hospital sent your labs to an out-of-network lab provider, appeal to have those covered under your in-network benefits.
If you were billed an upcharge for a private room but didn’t specifically request one, ask the hospital to drop the charge.
Once you have confirmed that the “Patient Responsibility” on each bill matches each EOB, follow these strategies to reduce the cost of your total medical bill.
Note: As always, you should ensure that you are seeing in-network doctors at in-network facilities. Confirm your doctor and hospital are in-network well in advance of your delivery to minimize billing complications.
5. Most insurance plans have expectant mother programs that offer tons of advice and discounts. (Remember, a healthy pregnancy for you means lower costs for them).
For example, Cigna Healthy Pregnancies, Healthy Babies offers the following:
A health coach with nursing experience that you can talk to about discomfort during pregnancy, foods to avoid, birthing classes, and maternity benefits
A pregnancy journal with information, charts, and tools
24/7 access to live support
An “incentive” if you enroll by the end of your second trimester or “an even higher incentive” if you enroll by the end of your first trimester
Call your insurance company at the number on the back of your insurance card as soon as you find out about your pregnancy to see what your plan offers.
Learn more about insurance plan discounts.
6. Breast pumps are FREE!
Yes ladies, you read that right. You do not have to pay for a breast pump, as the ACA mandates that they are covered at 100% with a prescription.
“Your health insurance plan must cover the cost of a breast pump. It may be either a rental unit or a new one you’ll keep. Your plan may have guidelines on whether the covered pump is manual or electric, the length of the rental, and when you’ll receive it (before or after birth).” - healthcare.gov
Call your insurance company to find out which brands they cover and how you need to purchase it, as it varies by insurer.
7. If you are pregnant and do not have health insurance, you are likely eligible for Medicaid and/or CHIP.
Medicaid is a state-administered government program that most commonly provides healthcare coverage for low-income people, families and children, and pregnant women. Access the national Medicaid website, to see what your benefits are. Eligibility and benefits vary on a state-by-state basis, but typically include income, household size, disability, family status, and other factors.
The Children’s Health Insurance Program (CHIP) provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, it may cover pregnant women.
Many women apply for Medicaid after their baby is born, but don’t realize all of the benefits of applying during the pregnancy. These include:
Prenatal care for the baby
Automatic coverage for your baby from birth to the 13th month with no application
Not sure where to begin? Set up a free appointment with a Healthcare Navigator. They will walk you through your eligibility for Medicaid and the plans on the marketplace. They can also answer questions about how the health insurance plans work and can help determine which one is best for you. Find your local Healthcare Navigator here. Hint: Try to work with an “Assister” rather than a “Broker.” Learn more about Medicaid.