Get answers to frequently asked questions about health insurance for pregnant women in Madison, WI.

Frequently Asked Questions about Health Insurance for Pregnant Women in Wisconsin

The Affordable Care Act (ACA) mandates insurance companies to provide certain benefits to pregnant women, including specific prenatal care, childbirth benefits and certain coverage for babies and children. Following are some frequently asked questions about health insurance for pregnant women in Wisconsin –


  1. What kind of insurance plan may be right for me? It is important that pregnant women choose an ACA-compliant health insurance plan. All of the plans available on the Health Insurance Marketplace (healthcare.gov) are ACA-compliant, meaning that they provide essential health benefits that cover services specific for women, pregnant women and newborns in Wisconsin. ACA-compliant plans can also be purchased directly from insurers. For example, all of Unity’s plans are ACA-compliant and provide essential health benefits. Another important factor pregnant women should consider when looking at health insurance plans is the health care network associated with each policy. If you have a favorite doctor or clinic, or prefer a certain hospital for the birth, it’s important to make sure the policy you choose includes those providers in its network.

  2. What if I become pregnant and then find that I don’t like my health insurance plan?
    If you’re pregnant and would like to switch health insurance plans, you may do so during the open enrollment period. However, if you become pregnant outside of this time period, you will need to wait until after the birth of your child to switch insurance companies, unless you have a qualify for Special Enrollment Period prior to the birth of your child. Once your child is born, a change in family size qualifies you for a “​Special ​Enrollment Period” (SEP), allowing you to buy insurance outside of the open enrollment period. You will have 60 days after the birth to enroll in a new health plan.1

  3. What should I do if I’m planning to get pregnant?
    It is important that pregnant women or women planning to get pregnant have adequate health insurance. Check the coverage of your existing health plan. If you purchased a plan after March 23, 2010, it is likely to cover essential health benefits, including some types of prenatal care, childbirth and newborn care. Specifically check what your plan covers and where your doctors, clinics and hospitals are located, then compare it to the types of services and medical professionals you'd like to use during your pregnancy and birth.

    If you have an older plan that hasn’t changed much since March of 2010, check it carefully. These health plans may be “grandfathered” and may not provide the same prenatal, natal and post natal care as newer plans. If it doesn’t provide the coverage you feel you need, you may change plans during open enrollment.

  4. Can an insurance company turn me down because I’m pregnant?
    By law, pregnant women in Wisconsin cannot be turned down for health insurance.

  5. What if I’m pregnant and I don’t have health insurance?
    If cost is not an issue, see a physician and make sure you receive prenatal care. If you can’t afford to go to the doctor, you may be eligible for the BadgerCare Plus program. This program has no specific enrollment period, so you may enroll when you think you are pregnant.2 BadgerCare Plus Prenatal Services provides health care for pregnant women who have been denied BadgerCare Plus because of their immigration or citizenship status, or who are in prison or jail.3 Otherwise, you can access this list of free or low-cost clinics in Wisconsin.

     

  6. What services are covered by health insurance for pregnant women and newborns under the ACA?
  7. Pregnant women with ACA compliant health plans receive the following benefits –

    • Prenatal care office visits
    • Delivery
    • Breastfeeding support and counseling
    • Gestational diabetes screening
    • Hepatitis B screening
    • Rh Incompatibility screening
    • Urinary tract infection screening
    • Screening and immunizations for the newborn
    • Other benefits depending on the situation

Do you have more questions about health insurance for pregnant women and newborns?  Unity can help! Contact us today for answers and more information!