Health insurance before pregnancy

Health insurance (also called health coverage or a health plan) helps you pay for medical care. Health insurance is really important for you, especially if you’re planning to have a baby. 

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. It’s important for you to know if you have these conditions and get the right treatment so you’re as healthy as you can be when you get pregnant. 

What health care services are covered for a woman before pregnancy?

The Health Insurance Marketplace (also called Marketplace) is an online resource that helps you find and compare health plans in your state.  After the  Affordable Care Act (also called ACA) passed, health care law says that insurance plans in the Marketplace have to cover these services for everyone:

• Regular health checkups and preventive care services with no co-pay. No co-pay means you don’t have to pay each time you get health care, like for a visit to a health care provider. Preventive care includes things like vaccinations, screening tests and even birth control. These can help prevent certain health conditions or find them early so you can get started on treatment. 
• Ambulatory patient services (also called outpatient care).  This is when you get care without having to stay in the hospital like checkups when you’re sick
• Hospital care like surgery and overnight stays
• Emergency services
• Pregnancy, maternity and newborn care
• Mental health services
• Prescription medication
• Rehabilitative and habilitative services. These are services to help people with injuries, disabilities or chronic conditions.
• Laboratory services like if you need a blood screening test done
• Pediatric (for children) services

There are also some preventive care benefits specific to women who may become pregnant. All Marketplace health plans and many other plans must cover these without a co-pay. Services covered that are specifically for women who may become pregnant include:

• Screening for anemia, syphilis, cervical cancer, diabetes and sexually transmitted infections
• Folic acid supplements
• Birth control
• Domestic violence screening and counseling

Health care law says that a plan can’t:

• Drop your health insurance if you get sick
• Charge you more for health care services because you’re a woman
• Charge you more for health care services if you’ve had a medical condition in the past
• Set a lifetime or annual cap (limit) on coverage. This means that an insurance company can’t stop covering your medical expenses once they reach a certain amount of money. This goes for your partner, too. 
• Make you pay unlimited costs out-of-pocket. Insurance plans have to set yearly limits on what you pay on your own for health care. Once you reach the limit, the company has to pay your expenses through the rest of the year. 

Do you need a referral to see your prenatal care provider before pregnancy?

No. The health care law after ACA says that you can see a prenatal care provider (like an obstetrician/gynecologist, nurse-midwife or nurse practitioner) without a referral from your primary care provider (someone who gives you basic health care). So you don’t need a referral from a primary care provider to see a prenatal care provider for things like birth control before pregnancy and prenatal care during pregnancy. 

If you’re planning to get pregnant, how do you know what health insurance to choose? 

When you’re choosing your health plan, look at the plan summary. Each plan has a summary that includes the expected costs of pregnancy care. Every plan uses the same summary form so you can compare costs and services. Use the summaries to help you get financially ready for pregnancy. 

You can find plan summaries in the Health Insurance Marketplace. This is an online resource that helps you find and compare health plans in your state. 

Last reviewed: September 2020