A doctor and a pregnant woman

Maternity Health Insurance in Florida: Coverage Guide

March 25, 2024

Being pregnant is a wonderful time in your life. Before your little one arrives, it’s important to consider your healthcare needs and what care your future baby will need. Maternity health insurance covers medical expenses related to pregnancy, childbirth, and the postpartum period. It is considered an essential health benefit under the Affordable Care Act (ACA).

Overview of Maternity Coverage

Maternity coverage covers health expenses related to pregnancy, childbirth, and postpartum care. This includes visits to your OB/GYN, ultrasounds, fetal tests, labor and delivery fees, and aftercare.

Before 2014, maternity coverage was not required, and only about 12% of insurance plans offered it. Today, all providers that sell health insurance to individuals, families, and groups are required to provide maternity coverage.

In addition to covering your healthcare needs during pregnancy and childbirth, maternity health insurance also includes newborn baby care.

Types of Maternity Health Insurance

When it comes to having coverage for your pregnancy, you can look for maternity benefits in an individual plan, family plan, or your employer-sponsored plan. Because of ACA requirements, insurance providers are required to offer maternity benefits as part of their basic coverage and not as an add-on (rider).

Employer-Sponsored Plans with Maternity Benefits

Your employer-sponsored health insurance plan has to include benefits for your needs during pregnancy, labor and delivery, and the postnatal period. The exact coverage details will vary from each policy, so check with your manager or human resources department to learn more. It is important to know factors like coverage limits and in-network providers, such as what hospital you can give birth in.

Individual or Family Plans Covering Maternity Care

Private health insurance offers more options when it comes to coverage, so you can personalize your policy to suit your preferences and needs. HMO plans that require you to go in-network for all your maternity healthcare will cost less, but some find that this does not offer enough options for providers based on their location. On the other hand, a PPO lets you see any provider you want who accepts your coverage, expanding your access to different providers and hospitals.

PPOs have the most versatility, so they also have the highest premiums each month. Meanwhile, a POS allows you to see providers outside your network, but you will need a referral from your primary care provider first.

Key Maternity Health Insurance Coverage

There are four broad categories of maternity health insurance that you should focus on when comparing policies and weighing your options. This coverage is not designed to replace any type of private health insurance but instead offer specific coverage during the pre and postnatal periods.

Prenatal Care Coverage

Prenatal care includes regular checkups, screenings, and tests to ensure that you and your baby are healthy throughout pregnancy. In addition to regular check-ups, you may also receive coverage for specific tests, like a screening for gestational diabetes or hypertension.

You typically need to see the doctor once a month during the first 28 weeks of pregnancy and once every two weeks from week 28 to 36. When you’re closer to your due date (weeks 36-40), you will likely see your doctor once a week until you go into labor.

Your OB/GYN will help you determine the right schedule for you and your baby. If you have a high-risk pregnancy, then you may need to see a doctor more regularly, as well as visit a specialist and have additional tests for your baby.

Hospital and Delivery Coverage

Inpatient hospital care for a delivery can cost up to $18,865 with many parents paying up to $3,000 out-of-pocket. If you need a Cesarean section or elect to have one, the cost can increase to up to $26,280. Having health insurance can save you thousands of dollars that you can save for your growing family. Not to mention it gives you peace of mind knowing that any care you require can be covered after meeting your deductible.

Postnatal Care and Follow-Up

Postnatal care includes visits to your doctor and may include a trip to the pediatrician based on your coverage. Remember, having a baby qualifies as a life event in health insurance, which means you’re allowed to buy a new policy — this is the time to invest in a family plan that covers you and your baby. You can also apply for Children’s Health Insurance Program (CHIP), Medicaid for kids that provides coverage if your income is too high for Medicaid but too low to afford private health insurance.

Maternity Health Insurance in Florida

Florida offers various types of health insurance with maternity benefits that are public and private. Medicaid pregnancy coverage in Florida is available at no-cost to people who qualify. Eligible women with low incomes can qualify for Presumptive Eligibility for Pregnant Women (PEPW). The Florida Department of Children and Families (DCF) determines eligibility for Medicaid, which can cover you for the rest of your pregnancy if you are unable to afford your own health insurance.

If you can, finding out you’re pregnant is the perfect time to get in touch with your provider! Pregnancy is not considered a pre-existing condition, so you can also buy health insurance when you’re expecting. However, you cannot enroll in health insurance outside of the open enrollment period.

Choosing the Right Maternity Health Insurance Plan

When choosing the right health insurance plan, it’s important to look at cost factors like the premium, deductible, and out-of-pocket expenses.

  • The premium is the monthly cost you pay to have health insurance.
  • The deductible is the total amount you must pay for healthcare services before your health insurance pays for it.
  • Out-of-pocket expenses are what you pay until your deductible kicks in. Afterward, you will have co-pays, a form of out-of-pocket expenses that are a percentage of a service, e.g. 20% while your insurance provider covers 80%.

When planning for a family, it’s important to know that the cost of healthcare will increase, and you will also have to consider the costs of care for your newborn. They will need to see a pediatrician regularly, have vaccines, exams, and may need additional treatments in the future for any illness, injuries, or disabilities they have.

Other Considerations and Add-Ons

Having maternity benefits is helpful while you are pregnant and immediately following the birth of your baby. There are additional factors you may want to consider when buying health insurance or signing up for an employer-sponsored plan.

High-Risk Pregnancy Coverage

High-risk pregnancies require additional care, and they may require inpatient hospitalization, prescription medications, specialist visits, and additional tests. Be sure to closely evaluate what level of coverage a plan provides, so you can be covered if you and your baby need additional care.

Newborn Coverage

Newborn coverage includes all of the care your newborn needs when they are born, such as their hospital stay, screenings, and vaccinations. The exact length of coverage for newborns varies by provider.

Health Insurance for Every Stage of Life

Having a baby is an exciting period, and after your newborn arrives, you’ll enter a special enrollment period that allows you to add them to your health insurance plan (or buy a new one). Contact Live Health Insurance in Florida to receive free, personalized quotes from experienced insurance brokers.

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