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If you are pregnant and covered under a parent’s health insurance plan, their insurance will cover your pregnancy and childbirth. However, it is always a good idea to check with the insurance company because there may be some limitations or exclusions.
The ACA allows young adults up to 26 to stay on a parent’s plan regardless of whether they live away from home, are out of school or are married. But while the Affordable Care Act (ACA) improved health insurance coverage for young adults, it is important to be aware of the pregnancy loophole.
KEY TAKEAWAYS
- Affordable care act ensures that all individual and small group health plans offer coverage for pregnancy, as well as maternity care services.
- According to federal law, there is not the requirement for health plans to offer maternity coverage to dependent children.
- If you are pregnant and do not have coverage for maternity services or childbirth, you can buy a Medicaid or children’s health insurance plan.
- Most people can get maternity coverage through an employer-sponsored plan.
Will my parent’s insurance cover my newborn?
If you are dependent on a parent’s health insurance plan, it will not cover your newborn as a dependent. But it will cover prenatal care and childbirth. Because plans offer coverage during pregnancy and childbirth but not for the newborn, this is called the pregnancy loophole.
When your child is born, you will need to get health coverage for the newborn on your own. Your child may be entitled to Medicaid/CHIP coverage in your state, depending on your financial situation.
Do individual health plans cover pregnancy and maternity care services?
All individual and small group health plans are required to cover pregnancy and maternity care services, which are part of the 10 essential benefits. Among those services are a variety of pregnancy-related screenings, such as testing for gestational diabetes, as well as breastfeeding supplies and support. Under the Affordable Care Act, new health plans must cover a wide range of preventive-care services without charging a deductible, co-payment or co-insurance.
Federal law prohibits those plans from denying coverage or charging higher premiums for people who are pregnant.
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Does employer-sponsored health insurance offer maternity coverage to dependent children?
Although employer-sponsored health plans must cover pregnancy-related care for employees and their spouses, federal law doesn’t require those plans to extend maternity coverage to dependent children.
So, your 25-year-old can be on your health plan, but their child — your grandchild — cannot.
Most employer-sponsored health plans don’t extend coverage to grandchildren unless the employee is their legal guardian.
What if my parent’s health plan doesn’t cover my child?
The pregnancy loophole can cause significant headaches for expectant mothers. If your parents have insurance coverage through a large group plan, it will cover you as a dependent but not your spouse or your newborn child. However, there are options to ensure your newborn is covered:
- An ACA exchange plan: You can get an individual plan that covers your pregnancy. ACA plans are eligible for cost-saving subsidies based on income.
- A Medicaid or Children’s Health Insurance Program plan: This is only an option if you fall within income and state eligibility.
- Catastrophic health insurance: Catastrophic health insurance plans are available to people under 30. They offer low premiums and comprehensive coverage. However, they have high out-of-pocket costs.
- Short-term health insurance: These low-cost plans are an option, but make sure to read the fine print. Some short-term plans don’t cover maternity services.
- The special enrollment period (SEP): If you have a newborn, you are eligible for the special enrollment period and can enroll in a Marketplace health plan even if it’s outside the open enrollment period. When you enroll in the new plan, your coverage will start the day the baby is born. Keep in mind that maternity services are not covered.
Having a baby is costly, so ensure you have the health insurance coverage you need during your pregnancy. Likewise, your newborn needs health insurance protection.
If you are on your parents’ health insurance plan and get pregnant before turning 26, your parents’ plan will cover your prenatal care, childbirth/delivery, ultrasound and regular check-ups during your pregnancy. But your parents’ health plan will not extend coverage to your newborn child and you will need to get a different policy for them.
Frequently asked questions
Will my insurance cover my daughter’s pregnancy?
Does insurance cover ultrasounds during pregnancy?
How to apply for health insurance for an unborn baby?
Sources:
Kaiser Family Foundation. “I’m covered as a dependent under my parent’s plan and I’m pregnant. Will my parent’s plan cover my prenatal care and delivery? Will my parent’s plan cover my baby after he’s born? ” Accessed July 2022.
National Women’s Law Center. “Covered Through a Parent’s Plan? Your Prenatal Services are Covered “ Accessed July 2022.
Center on Health Insurance Reforms. “ I’m covered as a dependent under my parent’s plan and I’m pregnant. Will my parent’s plan cover my prenatal care and delivery? Will my parent’s plan cover my baby after he’s born.” Accessed July 2022.
