Does my plan cover maternity and newborn care?

Short answer: Yes. Maternity and newborn care are essential health benefits, so all ACA-compliant individual and small-group plans must cover them. Birth is a qualifying life event that opens a special enrollment period to add the baby.

Under the Affordable Care Act, maternity and newborn care are one of the ten categories of essential health benefits. That means ACA-compliant individual and small-group plans must cover pregnancy, prenatal and postnatal care, labor and delivery, and newborn care, and pregnancy cannot be treated as a pre-existing condition.

Most large employer plans also cover maternity care. Preventive prenatal services and certain breastfeeding supports are generally covered without cost-sharing when delivered in-network, though you will still owe normal cost-sharing (deductible, copays, coinsurance) for many services such as delivery.

Having a baby is a qualifying life event that triggers a special enrollment period, so you can add the newborn to your plan, typically within 30 to 60 days of birth. Notify your plan or employer promptly to make sure the baby has coverage from day one. Note that short-term plans and some other non-ACA options may exclude maternity entirely.

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