The short answer
Maternity and newborn care are essential health benefits under the ACA, so every Marketplace plan must cover pregnancy, childbirth, and newborn care — and you can't be denied or charged more for being pregnant. What you'll pay out of pocket depends on your plan's deductible, copays, and out-of-pocket maximum, since maternity care runs through your normal cost-sharing.
So the coverage is guaranteed; the cost depends on which plan you have.
What's covered and what it costs
Covered maternity care generally includes prenatal visits, labor and delivery, and postpartum and newborn care. Some preventive prenatal services are covered without cost-sharing, while the bigger costs of delivery apply toward your deductible and out-of-pocket maximum. Because a birth is a large medical event, your plan's out-of-pocket maximum is the number that caps your total exposure for the year — our guide to the ACA out-of-pocket maximum context aside, it's worth knowing yours.
If you're planning a pregnancy, a plan with a lower deductible and out-of-pocket max may be worth a higher premium.
The baby and your coverage
Having a baby is a qualifying life event that opens a special enrollment period, letting you add the newborn to your plan or change coverage even outside open enrollment. Adding the baby also changes your household size, which can increase your subsidy. Our guide to adding a newborn to your ACA plan context aside, our family health insurance overview covers building family coverage.
So budget for the delivery against your out-of-pocket max, and remember the birth itself opens a window to adjust coverage.
Frequently Asked Questions
Do ACA plans cover pregnancy?
Yes. Maternity and newborn care are essential health benefits, so every Marketplace plan covers pregnancy, childbirth, and newborn care, and you can't be charged more for being pregnant.
How much does having a baby cost on an ACA plan?
It depends on your plan's deductible, copays, and out-of-pocket maximum, since delivery applies toward your cost-sharing. Your out-of-pocket maximum caps your total for the year.
Does having a baby let me change my plan?
Yes. A birth is a qualifying life event that opens a special enrollment period to add the newborn or change coverage, and it can increase your subsidy by changing household size.
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