What Does Health Insurance Cover After Pregnancy?
You probably already know that most U.S. health plans cover a lot of prenatal care. But did you know they cover a lot of postnatal care, too? Here's all you need to know about the many services and treatments insurance usually covers after you have a baby.
It's so easy to get caught up in how health insurance will (or won't) cover your prenatal care while you're pregnant that it can be similarly easy to overlook how it'll cover your postnatal care.
That makes sense, of course. After all, many of the medical checkups and procedures you need to have done during your pregnancy are expensive. Making sure you won't have to pay for all of it out of your own pocket is important.
Still, it's important to know how your health plan will or won't cover all of the medical checkups and procedures that are needed after you give birth, too. Most aren't as pricey as the ones that are done before your baby's delivered, but they can add up to a pretty penny if your coverage is lacking in one or more ways.
Thankfully, U.S. health plans tend to cover a lot of the postnatal care new mothers--and newly born babies--require in the months that follow a pregnancy. Here's all you need to know about them.
One of the first postnatal or postpartum healthcare costs you'll want your insurance plan to cover: well-baby or well-child checkups.
The point of these doctor visits is to make sure both you and your newborn are doing well, and continue to do well, after you're sent home from the hospital following delivery.
To accomplish this, your physician will do the following during each of the many well-child visits that you'll likely schedule during your baby's first two years of like:
- check your baby's weight, length, and head circumference
- perform a thorough, head-to-toe physical exam
- give your newborn various shots
- address any problems, issues, or concerns
Your doctor takes and records the measurements mentioned above to ensure your newborn's development is progressing as it expected. And he or she does the physical exam to look for things like soft spots on your baby's head, fluid or infection in her ears, various skin conditions, heart murmurs, breathing difficulties, and more.
As for the vaccines and other shots, your physician will give them to your child over the course of a number of these checkups. For example, most babies receive their first hepatitis B shot shortly after they're born, while they're still in the hospital. They receive their second shot one to two months after birth (at one of these well-child visits) and their third when they're between six months and 18 months old.
Speaking of which, expect to add a bunch of these check-ins to your calendar during the first two years of your baby's life. The first usually happens just a few days after you bring your newborn home from the hospital. Later ones typically follow two weeks after birth as well as at two, four, six, nine, and 12 months. And in year two, you'll probably return for three or four more checkups.
So many of these visits are needed because your baby grows and develops at a phenomenal rate in her first couple of years outside your womb. They allow your physician to closely monitor that growth and development and to keep an eye out for any issues or problems that might negatively impact it.
No matter what kind of health insurance you have, it should cover all or most of these visits. That's especially true if you got your plan from the marketplace or directly through an insurer, as the Affordable Care Act (aka the ACA or "Obamacare") requires such coverage.
That said, if your plan, or the plan covering your child, limits how many times he or she can see a doctor in a given year, mention that to your physician so they can work with you to schedule these visits in such a way that they won't stress you out financially.
If you don't like your current health plan and want to change it, by the way, now's the time. Giving birth qualifies you for a special enrollment period. That means you can buy coverage through the federal or state marketplace--or directly from an insurance company--without waiting for the yearly open enrollment period to come around. You only have a limited amount of time to take advantage of this (usually 60 days), though, so don't drag your feet.
Before you enroll in a new policy, read our article, "How to Choose the Best Health Insurance Plan for Your Pregnancy."
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Postpartum Doctor Visits for Mom
Your baby isn't the only one who needs to see her physician shortly after leaving the hospital or birthing center. You need to do the same.
Don't worry, you won't have to go in six or more times between when your baby is born and when you celebrate her first birthday. In fact, you'll probably only have to go in once.
When? If you have a C-section, you'll want to see your doctor a week or two following delivery. If yours is vaginal birth, though, waiting four to six weeks after birth should suffice.
Either way, the main point of these postpartum visits is to ensure you're properly healing and recovering from the rigors of childbirth. Your physician also wants to see how you're doing emotionally and answer any questions you might have about yourself or your newborn.
Don't be surprised if your physician orders a few blood tests during this visit. He or she may give you one or more shots (such as a flu shot, or a tetanus, diphtheria, and pertussis booster shot), too.
Again, your health insurance should cover your postpartum doctor visit no matter what type it is. It may even cover it at no cost to you.
If you're not sure how your plan deals with these kinds of checkups, or if you have any questions about how it deals with them, contact your insurance company.
Preventive Health Services for Your Newborn
The Affordable Care Act does more than require most health insurance plans to cover well-baby checkups. It also requires them to cover all sorts of preventive care that isn't always included in those vital doctor visits.
Even better: it requires them to cover these tests, screenings, shots, and assessments at no cost to the policyholder. That means no copayment and no coinsurance. (This is true even if you've yet to hit your yearly deductible.)
To get these services free of charge, however, you must have a marketplace or small group health plan. Or you need to have Medicaid coverage. You also need to have a physician or other care provider in your plan's network administer them.
Here are the preventive tests, screenings, shots, and assessments in question, by the way (courtesy of healthcare.gov):
- behavioral assessments (you can have these done multiple times between when your baby is born and when she turns 17)
- blood pressure screenings (again, your health plan should cover these at regular intervals as your child ages)
- developmental screening
- gonorrhea preventive medication
- hearing screening
- hemoglobinopathies or sickle cell screening
- hypothyroidism screening
- immunization vaccines (including whooping cough, hepatitis A and B, inactivated poliovirus, measles, and varicella or chickenpox)
- iron supplements for children at risk for anemia
- oral health risk assessments (like the behavioral assessments and blood pressure screenings mentioned earlier, your plan should pay for a number of these between when your baby is born and when she turns 17)
- phenylketonuria (PKU) screening
- tuberculin testing for children at higher risk of tuberculosis
Breastfeeding Support, Counseling, and Equipment
Obamacare to the rescue, once again.
How so? Well, thanks to that 2010 law, most U.S. health insurance plans now have to provide breastfeeding support, counseling, and even equipment to pregnant and nursing women.
In other words, if you bought your plan from the federal or state marketplace, it'll include this kind of coverage. The same is true if you bought your plan directly from an insurer, or if yours is a small group plan.
The law doesn't force large group plans, the type large companies and organizations offer to employees, to cover these sorts of services, but most do anyway.
As for which kinds of breastfeeding support, counseling, and equipment we're talking about here, breast pumps are one example.
Specifically, the health insurance plans named earlier have to cover the cost of a breast pump if a policyholder who is about to give birth or just gave birth wants one.
Insurers do have a bit of leeway here, though. Some plans may stipulate they'll cover only manual or electric breast pumps. They also may cover only rental units or ones that the new mom will keep. And they might put limits on how long they'll continue to pay for rental pumps. Or they might stipulate when you can rent or buy a unit (such as before or after you give birth) if you want your plan to cover it.
As the above hopefully makes clear, there can be a lot of variation in how a health plan tackles this sort of coverage. Given that, contact your insurer during your pregnancy--or even before you get pregnant, if possible--and ask which breastfeeding services your policy covers.
During that conversation, be sure to ask about breastfeeding consultants, counseling, and classes as well, as your health insurance may pay for some or all of them, too.
The number of American parents who have their sons circumcised shortly after birth may be decreasing, but enough of them still do it that it's worth discussing how health insurance policies tend to cover this procedure--or if they cover it at all.
(If you're looking for statistics, 83 percent of U.S. newborns were circumcised in the 1960s, according to a recent study. That figure dropped to just 77 percent as of 2010.)
Unfortunately, it's not possible to offer up a blanket statement like "most health plans cover circumcision." That's because some plans do, and some don't.
On top of that, it seems as though the trend is for health insurance plans to not pay for this procedure due to the abovementioned decline in parents who are having it done.
Some good news here: if you're forced to pay for your baby's circumcision out of your own pocket, you should only have to pay between $300 and $600 for it.
Still, most new parents could put that money to good use. So if you're pregnant and you're pretty sure you'll want to circumcise your son, contact your insurance company and see if they'll pay for it.
Even if they will, they may put certain limits on that coverage. For example, they might require you to do it while you and your newborn are still in the hospital. Or they might require you to do in within 30 days of birth.
Are you on Medicaid? If so, know that 16 state programs currently don't cover circumcision. The states in question:
- North Carolina
- North Dakota
Frequently Asked Questions
Q: What if my baby is born prematurely? Or what if she has to stay in the hospital longer than usual for some other reason? Will my health plan pay for that?
A: Yes, your health insurance will help pay for this kind of care. The key word here, though, is "help." In most cases, you'll still have to contend with your plan's deductible, copayments, and co-insurance costs if your baby is born early and needs to stay in the hospital longer than is typical.
If this happens to you and your family, contact your insurance company right away. Let them know what's going on and ask them to explain your financial responsibilities moving forward. Be sure to ask for specifics here. When will you be charged copays? When will you have to pay co-insurance?
Should you ever get to the point where you think you won't be able to afford the bills that will be coming your way, reach out to your local Medicaid agency. You may find you're eligible for that kind of assistance.
Q: What if I have to stay in the hospital longer than usual due to a complication or infection? Do most health plans cover that kind of thing?
A: Most health plans should cover this type of care, but don't take our word for it.
Again, once it's clear you need to extend your postpartum hospital stay, contact your insurer. Explain what is happening and ask for specifics regarding how your plan will and won't cover whatever care you're going to need.
Q: Does health insurance usually pay for contraceptives or other forms of birth control after a woman has a baby? If so, which ones do plans tend to cover?
A: Thanks to the ACA, all marketplace and most individual or small group health plans must cover certain contraceptive methods and even counseling costs for all women.
In addition, they have to cover these services without charging a copayment or coinsurance when an in-network provider administers them. And they have to do that even if the policyholder hasn't met their yearly deductible.
Some of the contraceptive methods the law requires these health plans to cover:
- barrier methods, like diaphragms and sponges
- hormonal methods, including birth control pills and vaginal rings
- implanted devices, such as intrauterine devices (IUDs)
- emergency contraception
- sterilization procedures
- patient education and counseling
Something these kinds of plans don't have to cover: drugs that induce abortions. They also don't have to cover services for male reproductive capacity, like vasectomies.
A few words of warning to women who work for religious organizations, such as churches or other houses of worship: they are exempt from this Obamacare requirement. The same is true of some non-profit hospitals, as well as some colleges and universities, that have religious objections to this type of coverage.
Q: Does Medicaid cover postnatal care?
A: In general, Medicaid covers prenatal care to the same extent as marketplace, off-marketplace (bought directly from insurance companies), and small group plans.
That means Medicaid should pay for:
- a postpartum doctor visit for mom
- well-baby checkups for the newborn
- various preventive health services
- breastfeeding support, counseling, and equipment
One area where Medicaid differs from the other types of health plans named above: circumcision coverage. In particular, 16 states currently don't allow their Medicaid programs to pay for babies to be circumcised. If you live in one of those states, you'll have to pay for your child's circumcision out of your own pocket. (That could cost you anywhere from $300 to $600 or more.)
Q: How can I add my baby to my health plan?
A: The quickest and easiest answer to this question is to call or otherwise contact your insurance company. Or, if you get your health coverage through an employer, talk with someone in human resources. They can tell you exactly what you need to do to add your newborn to your health insurance plan.
Just don't drag your feet here, no matter which situation you're in at the moment. Most plans require you to add a child to your policy within 30 days of giving birth.
Also, if you're currently struggling to make ends meet, see if you're eligible for Children's Health Insurance Plan or CHIP coverage for your baby. If you are eligible, this agency will provide your child with low-cost or even free health services.
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