Finding out you’re pregnant can be a joyous occasion, but it can also be very intimidating. After getting over your initial excitement and shock, prenatal care will be the next thing on your mind. You are going to have to find a doctor and apply for insurance if you do not have it. Then you have to come up with a birth plan, submit yourself to tests and physical examinations. You may even start panicking a little bit when you think about everything that needs to be figured out. That’s completely normal.
The good news is, it is truly not as scary as it seems. Sure, there will be paperwork, doctor appointments, and tests, but it is controlled chaos. Your doctor will have the prenatal care routine all mapped out, and you won’t have to worry about a thing. Better yet, you don’t have to walk into it without any knowledge of what to expect. Almost every woman who has a baby in the United States goes through the same process, and it may seem like a lot, but it’s not.
What is Prenatal Care?
Prenatal care is an essential part of staying healthy during pregnancy. It is when a doctor (OB/GYN), midwife, or nurse monitors your baby’s development during the gestation period.
Why are Prenatal Visits Important?
Prenatal care can help reduce the risk of complications during the pregnancy and delivery. Your physician will also let you know what kind of diet you should eat to maintain your health and the health of your fetus. They will explain what substances you should stay away from while pregnant. The doctor will tell you what medications are safe for you to take during the pregnancy. Additionally, your doctor will help you control things like high blood pressure and diabetes. They may even refer you to other specialists to monitor those conditions through-out the pregnancy.
What Can You Expect at Your Appointments?
Don’t worry about your appointments if you are stressing out. Nothing crazy usually happens at the OB/GYN. At every visit, your doctor will test your urine, take your weight, check your vitals and check for the fetus’s heartbeat. As you get farther along, the doctor will also start measuring your belly to see roughly how big the baby is.
Near the end of the third trimester, when you are going to the doctor more frequently, your physician will check your cervix for dilation and check to see if it is shorter and thinner.
How Often Will You Visit the OB/GYN?
You are going to visit your doctor a lot. You will visit them so much that it will begin to feel as if you live there. If there are no complications involved in your pregnancy, your schedule will look something like this:
- 4 to 28 weeks: One visit per month
- 28 to 36 weeks: Two visits per month
- 36-40 weeks: One visit per week
If you have complications, you will probably have to go more often. But don’t worry, women who see their OB/GYN often while pregnant, generally have healthier pregnancies and infants.
Accessing and Affording Prenatal Care
According to the Kaiser Family Foundation, the average cost of prenatal care for a pregnant woman, who has no complications, is approximately $2,000. That includes an average of 12 doctors’ appointments ranging from $100 to $200 each. These visits will also include lab tests such as blood and urine tests, and at least one ultrasound. That price range does not cover the cost of the delivery itself, which can range from $3,000 for an uncomplicated vaginal birth to over $70,000 for a c-section.
Luckily, health insurance can offset most of those costs. The Affordable Care Act (ACA) has ensured that all health insurance policies cover maternity care. So, if you have private insurance, the out of pocket cost of your prenatal care will depend on your co-pays. You could also qualify for Medicaid or a policy under the Children’s Health Insurance Program (CHIP).
Maternity Care Under the ACA
Before the ACA went into effect by the Obama Administration, in 2014, women were often left without maternity care when they became pregnant. In fact, only 12 percent of insurance policies offered included maternity care. Not only did insurance companies refuse to cover prenatal care or only provided it through expensive riders, but they also denied women policies a lot.
The insurance companies refused to cover women in many states because they claimed many had pre-existing conditions. For instance, women who had previously been received medical treatment for sexual assault, cervical cancer survivors, or mothers who had a c-section did not qualify for coverage.
Before the ACA, women were also charged at least 30 percent more for insurance policies than men. Even on policies that excluded maternity coverage. And if you were pregnant before you purchased insurance, that pregnancy was considered a pre-existing in 45 states, and you would not have qualified for coverage.
All of that changed when the ACA went into effect. Maternity care was named one of the ten essential health benefits. The ACA ensured that all small group and individual plans covered it. Insurance companies also are no longer able to charge women more than men for the same policies. Finally, insurance companies were no longer allowed to deny insurance to people based on pre-existing conditions.
Private Health Care Plans
Although every insurance plan now offers maternity care, that does not mean you qualify for it all year around. You cannot opt out of buying health insurance during the open enrollment period, great pregnant months later and then buy a plan in the marketplace. In fact, the only state that allows year-round purchasing is Nevada. The other 49 states only enable people to purchase plans from on- and off-exchange companies during open-enrollment. If you have no insurance and become pregnant, the only other way to buy a private insurance policy is during a special enrollment period because you’ve met the requirements for a qualifying event.
The qualifying events that allow you to buy insurance during closed enrollment periods are as follows: Changes in the household, changes in residence, loss of health insurance, and miscellaneous changes.
Changes in Household
The first of the qualifying events that could make you eligible for a special enrollment period is a change in your household in the last 60 days. For instance, if you get married, and you pick a plan by the end of the month, you’ll have insurance coverage the first day of the following month. On the flip side, if you were legally separated or divorced and lost your health insurance, you would qualify. However, you must have lost your health insurance during the divorce or separation as a result of the divorce or separation. If while you were married you didn’t have health insurance, getting separated or divorced wouldn’t qualify you for a special enrollment period.
Another household change is death. If you had a marketplace plan with someone else and they died, resulting in your no longer being eligible for your place you qualify for special enrollment. Finally, if you had a baby, placed a child for foster care or adopted a child, you could get insurance that starts the day of the event even if you apply 60 days later.
Changes in Residence
Another way to buy insurance during a special enrollment period is a change in residence. For instance, if you moved to the U.S. from a foreign country or U.S. territory that would qualify. Also, if you are a seasonal worker moving to or from the place you live and work that would open a special enrollment period for you.
If you are a student moving to or from the place you attend school, you may qualify. If you moved to a new zip code or county and finally if you moved to or from transitional housing or a shelter you could buy insurance during special enrollment.
There is a catch to this, though, you only qualify for the special enrollment period based on residency changes if you had qualifying health insurance for at least one day during the 60 days before your move. The only time that is moot is if you are moving from a foreign country or U.S. territory.
Loss of Health Insurance
Losing your health insurance is another way to buy insurance during a special enrollment period. If you have lost your health insurance for the following reasons in the last 60 days or expect to lose it in the next 60 days you may qualify:
- Lost individual coverage for a policy you bought yourself
- No longer eligible for Medicaid or CHIP
- Losing job-based coverage
- Lost coverage you received through a family member
- No longer eligible for Medicare
You can visit Healthcare.gov and apply for a special enrollment period to be sure.
Finally, various changes in your life may make you eligible for a special enrollment period. For example, if you recently got out of jail or prison. You became an American citizen. Also, if you or starting or ending service with VISTA, NCCC, and AmeriCorps State and National.
Finally, if you gained status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder or membership in a federally recognized tribe, you may qualify to buy insurance outside of open enrollment.
Medicaid & CHIP
If you do not qualify for a special enrollment period or cannot afford a private insurance plan, you could apply for a Medicaid or Children’s Health Insurance Program (CHIP) policy.
Medicaid is a service that allows low-income families to access healthcare for free. All states offer Medicaid to help pregnant women access prenatal care. That means that unlike a private insurance policy, you will have no co-pays or deductibles. The Department of Human Services in each state handles Medicaid approval, and eligibility standards may vary.
However, there are some things that you will most definitely need to provide such as proof of pregnancy, income, and citizenship. After you apply for Medicaid either at your local health department or online, a caseworker will tell you exactly what they need from you.
If you do not qualify for Medicaid because your income is too high, you may be eligible for CHIP. The program the offers low-cost health insurance for children and pregnant women who earn too much to receive Medicaid. Unfortunately, while all states cover children, only 18 states and the District of Columbia cover pregnant woman, and that coverage varies widely.The following states cover pregnant women to some degree:
Only 16 of those states cover women for 60 days post-partum. Louisiana, Nebraska, and Oklahoma do not offer women care after their babies are born through the CHIP program.
- New Jersey
- Rhode Island
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Prepared in cooperation with the Parent.guide.