Tag: pregnancy

I am pregnant and plan to breastfeed my baby. How does the ACA affect breastfeeding services?

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.

I just found out that I’m pregnant and my baby is due in March. Can I enroll in a plan though the health insurance Marketplace?

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.

I’m covered as a dependent under my parent’s plan and I’m pregnant. Will my parent’s plan cover my prenatal care and delivery? Will my parent’s plan cover my baby after he’s born?

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.

What services do plans have to cover for pregnant women?

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.

I’m covered as a dependent under my parent’s plan and I’m pregnant. Will my parent’s plan cover my prenatal care and delivery? Will my parent’s plan cover my baby after he’s born?

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.

I’m low income and enrolled in subsidized Marketplace coverage now. I just found out I’m pregnant. Under my state’s rules, I now qualify for Medicaid. Do I have to drop out of the Marketplace coverage and enroll in Medicaid? If I don’t will I have to pay back the premium tax credit subsidy?

In nearly all states, pregnancy-related Medicaid provides the same (or similar) benefits as Medicaid for other adults and so is considered minimum essential coverage (MEC).  (In 3 states – Arkansas, Idaho, and South Dakota – pregnancy-related Medicaid only covers maternity care and is not recognized as MEC).  The general rule requires that people eligible for other MEC are not eligible for premium tax credits.  However, a special rule allows women who are already receiving APTC and who become pregnant and eligible for pregnancy-related Medicaid to choose whether to stay in their marketplace plan with APTC or enroll in the pregnancy-related Medicaid.   For example, women might choose pregnancy-related Medicaid because it does not charge monthly premiums or cost sharing for covered services.

If you decide to enroll in the pregnancy-related Medicaid (in all but 3 states), you will no longer be eligible for APTC while you are enrolled in Medicaid.    If you decide to enroll in the pregnancy-related Medicaid and live in one of 3 states offering limited benefits, you can apply for an exemption from the individual mandate and won’t owe a penalty for lacking MEC coverage during those months.  In all states, when your pregnancy and pregnancy-related Medicaid ends, you will be eligible for a special enrollment period (SEP) and can sign up for marketplace coverage and APTC at that time.

But if you prefer to stay in your marketplace plan you can continue receiving APTC and won’t be required to pay it back later just because you were eligible for pregnancy-related Medicaid.

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