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This will vary by state. Some states have requirements that plans cover some infertility services, but there is no national requirement for coverage of infertility services. If you need these services and are shopping for coverage, check the plan details about coverage and out of pocket charges for infertility care.
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The ACA requires that all new ACA-compliant plans, including those in the employer market, individual market, and health insurance Marketplaces, cover lactation counseling and breast pump rental without any charge. Check your plan details to find out the specific number of counseling sessions and type of breast pump that it covers, or if your plan covers purchase of a breast pump. If you are nursing and work for a large employer (50 or more employees), your employer must provide access to a private room (that is not a bathroom) and break time for you to express milk.
Short-term health insurance policies do not have to provide benefits required by the ACA, including breastfeeding services.
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Yes. However, you may only enroll during Open Enrollment period (November 1, 2016 – January 31, 2017). Once enrolled, your plan will be required to cover maternity services. You may also qualify for a premium subsidy, depending on your family income and your eligibility for employer coverage. Once born, you can add the baby to the plan. You will also be allowed to change plans at that time. Birth of a child is a qualifying event that allows you to enroll in or change your coverage, no matter when during the year the baby is born. Your special enrollment period will last for 60 days from the date of birth. Adding the baby will change the plan premium and also your subsidy, assuming you qualify for premium tax credits. Depending on your income and the state you reside in, you might also qualify for Medicaid and there is not a limited open enrollment period for Medicaid.
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The rules are somewhat different depending on the plan your parents have.
If your parents are covered under a small employer plan (less than 50 workers) provided by an insurance company through the Marketplace or outside of the Marketplace, or if your parents are covered under a nongroup policy they bought themselves, then your parent’s plan is required to cover your prenatal care and delivery.
However, if your parents are covered under a group health plan offered by a large employer (50 or more workers), then your parent’s plan is only required to cover your prenatal care, but is not required to cover the delivery. Medicaid covers prenatal and delivery services in all states. You could see if you can qualify for Medicaid on your own.
Your parent’s plan, regardless of the source, generally won’t be required to cover your child as a dependent. You will be responsible for obtaining coverage for your baby. Depending on your income, your child may be eligible for coverage under the Medicaid/CHIP program in your state. Or, you can buy a family policy through the Marketplace and, depending on your income, you may be eligible for a premium tax credit to reduce your cost of that coverage.
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Federal law requires most employer and all ACA-compliant individual insurance plans, including those available through the Marketplaces, to cover maternity services including child birth and newborn care. These plans also must cover prenatal visits and screenings, folic acid supplements, tobacco cessation counseling and interventions, and breastfeeding services without any co-pay because they are considered preventive services. All state Medicaid programs cover maternity care without cost-sharing to low-income women who qualify for coverage.
Short-term health insurance policies do not have to provide benefits required by the ACA, such as preventive and maternity care, and most short-term plans will likely exclude maternity services.
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If you are enrolled in a non-grandfathered plan, then you must be allowed to see your OBGYN without a referral. Women in grandfathered plans and Medicaid may be able to schedule a visit with an OBGYN without a referral. Check with your plan.
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There are a number of ways that plans or employers can limit contraceptive services. Federal law requires that ACA-compliant plans must cover at least one form of each the 18 contraceptive methods for women identified by the FDA. But, a plan may apply reasonable medical management techniques such as prior authorization or step-therapy, and require cost-sharing for certain contraceptive drugs or devices to encourage an individual to use specific services or items within a chosen FDA approved contraceptive method. However, the plan must have a process in place to ensure that your particular contraceptive service or product is covered without cost sharing when your specific provider recommends it based on medical necessity. In addition, you must get your contraceptive care from an in-network provider. Insurers may charge cost sharing if you go to an out-of-network provider for contraceptive care.
In addition, if your employer is affiliated with a faith-based organization, they can limit the types of contraceptives they wish to cover based on religious objections. Specifically, all houses of worship are exempt. Other employers and universities that are affiliated with faith-based organizations that oppose some or all contraceptive methods may also opt to exclude coverage, and have the insurance company provide the contraceptive coverage directly to policyholders. There is ongoing litigation about which employers are exempt and can exclude contraceptive services.
Short-term health insurance policies do not have to provide benefits required by the ACA and may not cover preventive services including contraceptive services.
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Contraceptives, including sterilization, are covered only for women as preventive services by ACA-compliant plans. Since sterilization for men is not considered a preventive service under the Affordable Care Act, federal law does not require plans to cover vasectomies. However, seven states (Colorado, Illinois, Maine, Maryland, Oregon, Vermont and Washington) require individual and fully-insured group health plans to cover vasectomies. State laws vary on cost-sharing requirements. Check with your State Department of Insurance for more information.
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It depends. Your Family Planning Clinic may be a covered provider in your new health plan network. If so, you can continue to go there for your birth control without cost-sharing. If your Family Planning Clinic is not in the network, you may still qualify for free or reduced cost services from the clinic. Check with your clinic for more information.
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The rules affecting student health plans are complicated and depend on the type of plan your college or university may offer. If your student health plan is fully-insured, it should cover all 18 FDA-approved contraceptive methods for women as prescribed, without cost sharing. However, if your college or university has a religious objection to providing contraceptive coverage, then it may have opted to have the insurance company provide the coverage directly to policyholders. Some universities have legally challenged the contraceptive coverage rule. While this litigation is ongoing, some universities may have excluded contraceptive coverage from their student health plan.
If your college has a self-funded health plan, then it is not subject to requirements under the Affordable Care Act, including covering contraceptives with no cost sharing. Ask your college if the plan is self-funded. If it is self-funded, state laws that may require some coverage of contraceptives. Check with your State Insurance Department about the state law. You may have other options as well. If you are under 26, you should check if you are eligible as a dependent in your parent’s health plan. You can also consider buying coverage on your own through the Marketplace. If your income is between 100% and 400% of the federal poverty level and you meet other requirements, you can qualify for premium tax credits; if you income is between 100% and 250% of the federal poverty level, you can also qualify for cost sharing reductions. In addition, you might be eligible for Medicaid. Check with your state Marketplace to find out if you meet the income and other eligibility standards to enroll in Medicaid coverage.