You are Pregnant! The ACA and Pregnant Women and Mothers

Will the Affordable Care Act make it Easier for Me to Get Insurance?

Before the ACA, some insurance companies could decide not to give insurance to people with a “pre-existing condition.” A pre-existing condition is a health condition that started before someone joined a health care plan. Some insurance companies said pregnancy was a pre-existing condition. This meant that a pregnant woman often had a hard time getting health insurance.

Under the ACA, insurance companies cannot deny coverage to pregnant women and other people with pre-existing conditions. However, this does not apply to grandfathered individual health plans. For more information about grandfathered plans, click here.

Will My Insurance Cover My Care?

Before the ACA, many individual health plans did not cover maternity care. Maternity care is health care a woman receives during pregnancy, childbirth, and after delivery. This meant women had to buy extra insurance when they became pregnant.

The ACA makes maternity and newborn care essential health benefits. Essential health benefits are ten health care service categories that must be covered by insurance plans in order to be included in the Health Insurance Marketplace. Beginning January 1, 2014, non-grandfathered plans and small group plans are also required to cover the essential health benefits including maternity care.

What Else Will My Insurance Cover?

Under the ACA, non-grandfathered health plans must cover for certain preventive services without cost-sharing (copays, co-insurance, and deductibles). For pregnant women, these include:

This does not apply to grandfathered health plans, although many grandfathered plans already offer this coverage. For more information about preventative services related to pregnancy and women’s health, go to: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7987-02.pdf.

Do I Have to Pay More for Insurance Because I am a Woman?

Before the ACA, insurance companies could charge women more for insurance. This was called “gender rating.” Under the ACA, insurance companies can only increase premiums based on:

  1. The number of people being covered on your plan
  2. Where you live
  3. Your age
  4. Whether you use tobacco

Insurance companies cannot increase premiums because of your gender, your job, or your health status. This does not apply to grandfathered plans or large employer plans.

What About Breastfeeding?

The ACA requires employers with 50 or more employees to provide nursing mothers with break time and a private space that is not a bathroom to express milk. Employers must provide this for 1 year after the birth of the child.

Where Can I Find More Information?

The Kaiser Family Foundation has a whole section devoted to the Affordable Care Act and women: http://kff.org/womens-health-policy/

The National Partnership for Women and Families has developed several fact sheets about how the Affordable Care Act affects women: http://www.nationalpartnership.org/site/PageServer?pagename=issues_health_reform_anniversary

The federal government has created a short site about the Affordable Care Act and pregnancy: https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/