How to Navigate Health Insurance When You’re Expecting

If you’re planning to grow your family—or just found out you’re expecting—your health insurance suddenly becomes a lot more important. From prenatal visits to labor and delivery, the right coverage can save you thousands and reduce a ton of stress along the way.

Here’s how to make sure your insurance is set up to support you every step of the way.

Check Your Plan’s Maternity Coverage First

Not all health insurance plans treat maternity care the same way. While all ACA-compliant plans must cover prenatal, delivery, and postpartum care, the way those services are billed—and how much you pay—can vary.

Here’s what you need to confirm right away:

• Are your preferred OB-GYN and hospital in-network?

• What’s your deductible and out-of-pocket max?

• Does your plan cover ultrasounds, labs, and genetic testing?

• Are there limits on the number of prenatal visits?

Don’t just assume coverage is “automatic.” Even within ACA guidelines, costs and networks vary widely.

Understanding the Full Maternity Timeline

Pregnancy-related health needs span a full year—or more. Knowing what services are covered at each stage can help you prepare and avoid unexpected bills.

Maternity Coverage by Phase

Choosing the Right Provider and Hospital

Even if your plan covers maternity care, choosing the right provider is critical. Make sure your OB-GYN, midwife, or birthing center is in-network. Also check:

• Which hospitals they deliver at

• Whether those hospitals are in your plan’s network

• If the hospital has a NICU in case of complications

• If there are separate billing departments (labs, anesthesiology, etc.)

Ask your provider’s billing office to run a benefits check before major procedures or tests. This helps avoid surprise bills.

Understanding Delivery Costs

Labor and delivery are often one of the most expensive parts of maternity care. Even with insurance, your out-of-pocket costs can be high depending on:

• Your deductible

• Coinsurance after the deductible

• Whether you’ve already met any of these

• Hospital or facility charges

Some plans have a single copay for hospital admission, while others apply standard coinsurance. Make sure to ask what’s included—sometimes even baby’s first checkups are billed separately.

Adding Your Newborn to Your Insurance

Once your baby arrives, you’ll need to add them to your plan. Most plans allow 60 days after birth to enroll your newborn in coverage, even outside of open enrollment.

You can:

• Add your baby to your employer plan

• Add them to your Marketplace or Medicaid plan

• Enroll them in CHIP if you qualify based on income

Coverage is usually retroactive to the date of birth, but you’ll still need to notify your insurer and provide documentation (like a birth certificate) promptly.

What About Medicaid and Pregnancy?

If you don’t have insurance or your income is below a certain level, you might qualify for Medicaid or a pregnancy-specific Medicaid plan. These plans:

• Cover all required maternity services

• Often include extras like doula support or transportation

• Typically have little or no cost-sharing

Eligibility rules vary by state, and coverage usually extends at least 60 days postpartum—though some states offer longer support.

Don’t Forget About Postpartum Care

The postpartum period can bring physical recovery, mental health shifts, and infant care challenges. Your plan should cover:

• Postpartum visits (usually 6 weeks after delivery)

• Mental health screenings

• Breastfeeding consultations

• Birth control or family planning services

If you’re experiencing depression, anxiety, or physical symptoms beyond what feels typical, talk to your provider early—and ask what mental health support is covered.

Tools and Benefits to Look For in 2025

Many health plans now offer extras that can make pregnancy easier to navigate. Ask about:

• Pregnancy apps with telehealth support

• 24/7 nurse lines

• Maternity case management (a nurse or rep who guides your care)

• Breast pump coverage (required by ACA)

• Lactation classes or support groups

• Prenatal vitamins (some plans cover these)

These perks can add up to significant value—especially if you’re a first-time parent.

Marketplace Plans and Pregnancy

If you’re shopping for a Marketplace plan while pregnant, you may be eligible for a Special Enrollment Period if you’ve recently lost coverage or had a life change.

Important tip: Pregnancy alone doesn’t qualify for a Special Enrollment Period unless you’re also experiencing another event (job loss, marriage, etc.). However, having a baby does qualify you, so you can enroll after birth.

Summary: Top Tips for Navigating Maternity Coverage

• Confirm that your OB-GYN, hospital, and labs are in-network.

• Understand your deductible and how it affects delivery costs.

• Review coverage for prenatal tests, ultrasounds, and postpartum care.

• Add your newborn to your insurance plan within 60 days.

• Explore Medicaid or CHIP if you’re income-eligible.

• Use all available extras—nurse lines, apps, classes, and support services.

Pregnancy is a major life event, and your health insurance should help support—not complicate—it. A little prep now can help you avoid stress, surprise bills, and coverage confusion when you’re focused on welcoming your baby.