The Affordable Care Act (also called the ACA or Obamacare) gives Americans new choices in health insurance (also called health coverage or health plan). Health insurance helps you pay for medical care.
The law makes new rules for the kinds of health care services that a health plan offers and what you have to pay for these services. Certain services may be important to you if you’re pregnant, thinking about getting pregnant or already have children. Learning what different plans cover and how much they cost can help you choose a plan that’s right for you and your family.
The ACA says that all insurance plans have to fully cover preventive care services for women with no co-pay. These are services, like vaccinations and screening tests, that can help prevent certain health conditions or find them early so you can get started on treatment. For example, you can get services like a well-woman checkup, breast cancer screening or birth control without having a co-pay. A co-pay is money you pay for each health care service you get, like a visit to a health care provider.
To see a list of covered preventive health services for women, go to: www.healthcare.gov/what-are-my-preventive-care-benefits#part=2
The ACA also makes sure you can see a provider for women’s health services without a referral from your primary care provider. Women’s health services include things like birth control, breast cancer screening and prenatal care. So you don’t have to go to your primary care provider (someone who gives you basic health care) first to get an OK to see a women’s health provider, like an obstetrician/gynecologist (also called OB/GYN), nurse-midwife or nurse practitioner.
If you’re pregnant or thinking about getting pregnant, how does the ACA affect your health care?
It’s a great idea to find out about and get treated for health conditions before you get pregnant. Some health conditions, like high blood pressure and diabetes, can cause problems during pregnancy. So it’s important to make the most of preventive health services for women covered by the ACA, especially if you’re starting a family.
The ACA says that health plans have to cover many services for pregnant women, including:
When you’re choosing your health plan, look at the plan summary. Each plan has a summary that includes the expected costs of pregnancy under that plan. Every summary uses the same form, so it’s easy to compare costs and services. Plan summaries are available in the Health Insurance Marketplace. This is an online resource that helps you find and compare health plans in your state. Find your state’s Marketplace at: www.healthcare.gov/what-is-the-marketplace-in-my-state
Some pregnant women need help paying for health insurance. In most states, pregnant women can get Medicaid coverage even if they earn more than other low-income adults. Medicaid is a government program that provides free or low-cost health insurance to people with low income. In some states, pregnant women who earn too much for Medicaid can get coverage through the Child Health Insurance Program (also called CHIP). CHIP is a government program that provides health insurance to children in certain families with low income. If you’re looking for insurance in the online Marketplace and you say you’re pregnant on the Marketplace application, you get specific information about these and other health plans for pregnant women.
For more about insurance and planning pregnancy, go to: http://www.marchofdimes.com/pregnancy/are-you-ready-financially.aspx
The ACA says that insurance plans have to cover certain health services for children, including:
To see a full list of health care services for your child that don’t have a co-pay, go to: www.healthcare.gov/what-are-my-preventive-care-benefits#part=3
Your child can stay on your health plan until age 26, even if he doesn’t live with you or is married. If this child isn’t covered by your insurance now, you may be able to add him to your plan. But you may have to add him in a certain amount of time. Check with your insurance plan about adding older children to your coverage.
If you get insurance through your employer, you most likely can get family coverage. This is a plan that takes care of you, your partner and your children. But getting help to pay for insurance for your children can be confusing. Sometimes children can get coverage that their parents can’t. Some states have health plans that only cover children (called a child-only plan). Sometimes children in the same family get different kinds of coverage depending on how old they are.
For more information on health insurance and children, go to: www.healthcare.gov/law/information-for-you/families.html
The ACA can help make sure that children with special medical needs have the health insurance they need to pay for services and treatment throughout their lives. For example:
Your child’s health can affect which insurance plan you choose. If your child has a medical condition, you may want to choose a plan that covers your child’s health care provider or prescription medicine. And if your child has a condition that requires special vision or dental care, you may want to choose a plan that covers those services. Some plans pay for vision and dental services for children, while others have limited coverage. Check the plan’s summary for a list of costs and coverage for children’s eye exams, glasses and dental checkups.
While some provisions take effect this September (see our In-depth article), the new law will not fully go into effect until 2014. In the interim, the March of Dimes is reviewing and commenting on the rules for implementation that are being issued by the Administration.
The March of Dimes will update this site on items that directly affect women of childbearing age, infants and children, but to get even more information about all of the advances, visit http://www.healthcare.gov/.
The first place to inquire is with your state insurance commissioner's office. The U.S. Department of Health and Human Services also has a Web site to help parents determine if their children are eligible for free or low-cost health coverage under the reauthorized Children's Health Insurance Program. Visit http://www.insurekidsnow.gov/ for more information.
Since our founding, the March of Dimes has worked to shape public policy that affects maternal and child health. Health reform offered an unparalleled opportunity to improve the health of and address the needs of women, infants and children. Specifically:
By law and longstanding tradition, the March of Dimes is strictly nonpartisan and remained nonpartisan throughout the debate. Initially, we worked with members with many different views and party affiliations, but as the debate went on, we focused our energies on ensuring that legislation likely to be approved contained the strongest provisions possible to address the unique health needs of children and pregnant women.