Health Insurance for Pregnant Women: Coverage for You and Your Baby

1. Medicaid Plan

Medicaid is a national health insurance program that provides health and long-term care coverage to low-income individuals, including pregnant women. In all states, Medicaid also provides pregnancy-related benefits without cost-sharing till the 60th day of postpartum.

Moreover, Medicaid covers most of the births in the U.S with its family planning services, providing financial aid for prenatal and maternal care. Furthermore, it covers other areas of women’s health plus reproductive health. 

Eligibility criteria:

It finances pregnant women with incomes up to 133% of the Federal Poverty Level (FPL).

Benefits Provided by Medicaid for Women’s health: 

Primary/Secondary care:

This health insurance for pregnant women covers both labor and delivery. 

Preventive care: 

Medicaid health insurance plan provides screening services for various health conditions for pregnant women or women who will become pregnant. It also includes counseling, prenatal care, and mammography. 

Mental health:

Medicaid provides coverage for mental illnesses, behavioral issues, or substance use disorder under Medicaid Expansion Program. 

Breast and cervical cancers: 

Medicaid insures women diagnosed with cervical or breast cancer under the prevention law through a federal screening program. 

Disability, aging, and long-term care:

Medicaid covers physical and mental disabilities and provides services like assistance, rehabilitation, transportation, etc. 

All the states must provide the mandatory Medicaid benefits, which include inpatient and outpatient hospital services, X-rays and laboratory services, family planning services, nurse-midwife services, etc. Also, the optional benefits vary with state. 

Enrollment for Medicaid 

You can enroll for Medicaid all year-round, but the chances of acceptance are slim because most states have reserved this health insurance for pregnant women belonging to poverty-stricken homes. Want to opt in for a Long-term option? know how you can buy long-term health insurance.

2. Affordable Care Act (ACA) Plans (Obamacare):

Affordable Care Act (ACA) Plans are also called individual major medical plans and provide a wide range of benefits. It has many preventive care services that are mostly women-specific. 

ACA plans give the 10 essential health benefits, including maternity and newborn care. 

The preventive care services covered by ACA Plans do not require any copayment or coinsurance for accessing them. It means you don’t pay your healthcare provider each time you visit.  

Eligibility criteria: 

• Individuals with any income can enroll in an ACA health insurance plan.
• However, to qualify for premium tax credit/special subsidies, an income between 100% and 400% FPL is necessary. 

Health Benefits Provided: 

• Contraception 
• Breast cancer mammography screenings 
• Prenatal care
• Well-women visits
• Labor and birth services
• Breastfeeding counseling without co-pay
• Cervical cancer screenings

Furthermore, the Affordable Care Act Plans also provides these services at any time to pregnant women:

• Emergency services 
• Hospital care 
• Regular checkups 
• Immediate checkups when sick 

The above lists ensure that the ACA plan provides extensive coverage and benefits and is suitable when looking for a health insurance plan for pregnant women at affordable costs. 

Enrollment 

• It is advised to enroll in an ACA plan when:
• You don’t qualify for Medicaid 
• You are ineligible for ACA subsidy 
• Or if you have pre-existing health conditions 

For most states, the open enrollment period runs from 1st November to 15th January. However, some states extend their open enrollment period. 

3. Children’s Healthcare Insurance Program (CHIP)

Originally, the children’s healthcare insurance program provides coverage to uninsured children, but in some states, it covers pregnant women. It is a government program that is the best alternative when you earn too much for Medicaid and too less for private insurance. So, if you are looking for a health insurance plan for pregnant women, it can be the one for you. 

Read below to learn further details about the CHIP perinatal program: 

Eligibility criteria for the CHIP perinatal program: 

• Income greater than 198% of the Federal Poverty Line (FPL) and below 202% of the FPL 
• Income below 202% of the FPL but cannot enroll in Medicaid due to immigration status. 
• Don’t have any other health insurance coverage 

Services covered by CHIP Perinatal Program: 

• Prenatal doctor visits 
• Labor and delivery 
• Prenatal vitamins 
• Regular checkups before and after leaving the hospital 
• Benefits for the baby 
• Prescriptions drugs services

How to choose the best women’s health insurance plan for myself?

To choose the best health insurance for pregnant women, consider the following factors that will help you in decision-making and conclude the best coverage, both financially and service-wise. 

• Estimate your total budget and consider out-of-pocket costs 
• Find quotes for prospective health insurance plans
• Compare the benefits provided with your needs 
• Evaluate chances for subsidies 

Once you have considered the above factors, compare everything, including premiums (monthly payment), deductibles, co-pay, and coverage for regular medicine, of all the plans and choose the best women’s health insurance for yourself. Furthermore, if you plan to get pregnant, select a coverage plan that provides pregnancy and childcare benefits. We also have collected the best health insurance companies, it will help  you to choose what you need.

Which one is the best program? 

If we analyze every aspect of the mentioned health insurance coverages for pregnant women, we conclude that Medicaid is the best program. Here are a few reasons why: 

• No specific enrollment period, meaning you can enroll at any time of the year
• No waiting time for acceptance 
• You may also qualify for free health insurance for women if pregnant or have low-income
• It regulated jointly by the states and federal government

When can you apply for health insurance to cover pregnancy? 

You can enroll during the Open Enrollment Period, which usually begins on November 1st of every year. Still, if you miss the enrollment period, you may be eligible for the Special Enrollment Period if you experience certain life changes. It includes: 

• Death 
• Marriage 
• Childbirth 
• Divorce or legal separation resulting in losing your coverage 
• Moving to a new place

Women’s Health Insurance coverage in Texas 

If you are a Texas resident looking for free women’s health insurance in Texas, you have come to the right place. Read below to learn about the Healthy Texas Women Program. 

What is the Healthy Texas Women Program? 

It is a women’s health insurance program in Texas that offers health and family planning services to women for free. Additionally, such medical services enable women to attain, manage, prevent, or postpone pregnancy while maintaining their general health. 

What are the eligibility criteria for HTW? 

This Texas women’s health insurance program is for:

• Women belong to low-income families. 
• Women aged 18 to 44 years old
• A U.S citizen or qualified immigrant 
• Women aged 15 to 17 years old with a parent or legal guardian
• Resident of Texas 
• Who previously doesn’t have a health insurance 

What are the benefits provided by the HTW program? 

In addition to family planning services, this women’s health insurance program also provides the following benefits: 

• Pregnancy testing
• Pelvic examinations
• Sexually transmitted infection services
• Breast and cervical cancer screenings
• Clinical breast examination
• Mammograms

Furthermore, this free women’s health insurance in Texas also offers an enhanced package for postpartum services called the “HTW Plus Program.”

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