In most states, before Jan. 1, 2014, U.S. women who needed individual health coverage for ordinary maternity care had great difficulty obtaining such coverage.
Aside from some health maintenance organizations, and some expensive maternity riders, most states had virtually no individual health coverage arrangements that would help with routine maternity costs.
Then, on Jan. 1, 2014, when the major provisions of the Affordable Care Act (ACA) took effect, maternity was deemed an essential health benefit.
The ACA required all new individual insurance policies sold on or after Jan. 1, 2014, to cover maternity care.
To get those individual major medical policies, women had to enroll in individual major medical coverage during an annual open enrollment period, or they had to have a “qualifying event,” such as loss of insurance due to job termination, marriage or divorce, that would give them access to a special enrollment period.
Some states, including Connecticut and New York, have legislated that becoming pregnant is also a qualifying event, meaning that becoming pregnant in those states gives a woman a chance to sign up for an ACA policy with maternity and newborn care benefits.
The ACA also gives a pregnant woman a chance sign up for coverage for her newborn. Even if a pregnant woman fails to get herself covered, she can still get a child-only policy after the birth of her baby. This provision is crucial in any case in which a newborn has medical complications, because neonatal intensive care typically costs $10,000 to $15,000 per day.
Although ACA-compliant policies must cover maternity care, they do not have to provide coverage for abortions and often are prohibited from doing so. “Twenty-five states restrict the availability of abortion coverage in Marketplace health plans. Two states restrict it entirely, and 23 restrict it to variations of the Hyde exceptions. The remaining states have no restrictions,” Amy Chen writes in a National Health Law Program article,
The ACA provides many other health benefits for women, including benefits for well-woman medical exams, breast cancer screening, domestic violence screening and counseling, and other preventive services.