The Obama Administration gave expectant moms a belated mother’s day gift. Guidance issued yesterday clarifies that new insurance plans must cover preventive prenatal services without cost sharing for all dependents — including expectant mothers enrolled on a parent’s plan. This is great news for expectant mothers who discover once they are pregnant that they don’t have maternity coverage under their parent’s plan.
What New Plans Must Cover
This guidance makes clear that preventive services related to preconception and prenatal care must be covered for all dependents without cost sharing. This means pregnant women — regardless of whether they are the insurance policyholder or not — will not pay anything for some prenatal office visits as well as important prenatal testing such as screening for gestational diabetes, sexually transmitted diseases and blood type, and other help with maintaining a healthy pregnancy, such as tobacco use counseling. The guidance also means that plans must cover other women’s preventive services dependents might need, including breastfeeding supports and supplies.
What Some Plans Might Not Cover
The guidance doesn’t solve all problems for dependents without maternity coverage. Unfortunately, some employment based plans still exclude dependent children — including adult children up to age 26 — from maternity coverage. Even with this new guidance, such plans might not cover the most expensive part of pregnancy — labor and delivery. However, these plans may be violating other parts of the law.
What Can I Do?
If you are pregnant, or planning to become pregnant, and hold health insurance through a parent’s coverage, you should contact your health insurance company or your parent’s human resources department to find out what services are covered under the plan.
If you were denied coverage for your prenatal services, first contact your plan and find out if they are “grandfathered.” If they are not “grandfathered,” then you should be receiving preventive services, including prenatal services, without cost sharing. You can appeal their decision using one of our template letters and submit a complaint to the Department of Labor.
If your current insurance does not meet your needs, you can enroll in Marketplace health insurance through healthcare.gov starting November 1 for insurance beginning on January 1. You may also qualify for Medicaid coverage during pregnancy — even if you are not eligible for Medicaid at other times.