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Maternity & Health Care Reform

Getting health insurance coverage as a pregnant woman  is nearly impossible unless you apply for Medicaid, though if women who happen to be insured before they conceive now have access to several maternity benefits that they once did not. Prior to the Affordable Care Act, maternity coverage was an additional benefit in many cases, or not offered whatsoever. New legislation based on the ACA’s requirements for preventive care have gone into effect, which now requires every single health policy in the nation to cover several different types of care surrounding pregnancy.

Preventive Care Benefits

Women with an individual or group health insurance plan are now able to access services covered at a level of coinsurance or available for no additional service charge. Already in effect by the ACA as preventive benefits with individual and employer-based plans is prenatal testing and screening for various diseases such as hepatitis B, syphilis, and iron deficiency anemia. Services offered during the prenatal stage include screening for gestational diabetes in women between 24 and 28 weeks of gestation to identify high-risk cases of diabetes. Because symptoms are typically non-existent or mild, this is a crucial exam to perform to ensure health of the mother and child alike. Gestational diabetes usually begins between the 24th and 28th week of pregnancy, hence the requirement for this screening. Diabetes is a growing issue among the American population, which makes this a very important preventive screening.

Postnatal care is also covered for breastfeeding supplies, counseling, and support with a trained medical professional. Either during pregnancy or after giving birth, a provider will work with the pregnant woman/new mother to ensure proper breastfeeding. For women whose plans allow for these benefits (non-grandfathered policies), breastfeeding education and supplies will be available without a copayment, coinsurance or deductible. Many infants have been subject to malnutrition and health issues as a result of not receiving proper nutrients. This preventive benefit will now help more infants become healthy children and give mothers the resources and knowledge to make that possible.

Maternity Care as an Essential Benefit

Essential benefits are required covered services under the health care reform law. Individual and small group markets must offer coverage for at least ten categories of care, which includes maternity and newborn care, in their plans as of January 1, 2014. Due to the fact that there are many categories, some health insurance companies may opt to not choose maternity and newborn care in certain plans and instead cover another category.

The nature of this law is highly emphasizing the need for maternity coverage, however, and state-run health exchanges will also abide by the essential health benefit criteria. If health insurance companies nationwide decide to implement maternity and newborn health care services into their plans, coverage for pregnant women will be much more sufficient than it has been in the past.

Pregnant Women Accepted for Private Insurance

The new health care law requires that insurance companies do not discriminate against any applicant for their health conditions, which includes pregnancy. This means women will not be turned down for health insurance if they are already pregnant when this law takes effect in January 2014. Changing the landscape of health insurance completely, the ACA will make a huge stride in insuring women who otherwise would have been immediately rejected due to their pregnancy.

While it is still a better idea to get insurance coverage before you become pregnant, sometimes life gives surprises and planning in advance is no longer an option. In 2014, thanks to the ACA, women who are uninsured and pregnant have more than just Medicaid to rely on for health care, though the Medicaid program is also highly recommended. Medicaid eligibility is currently narrowing its enrollment requirements with the exception in many cases of pregnant women, so this option is still open and incredibly valuable if you meet the income requirements. However, if your income is too high to qualify and you can afford a private plan when these laws take effect, by all means sign on with one of our favorites: Aetna, Kaiser Permanente (who already offers great maternity benefits), Coventry, Humana, or United.