Three Questions Every Current and Future Mother Should Ask About Her Health Insurance Coverage During Open Enrollment

SAN DIEGO, Oct. 30, 2020 /PRNewswire/ — As the annual open enrollment period begins for individual health insurance plans, Stand Up for APA, a nonprofit working to ensure that all women in the United States receive access to the most accurate non-invasive prenatal testing (NIPT) options, today encouraged all women to inquire about the maternal and prenatal benefits offered by health insurers and make sure they have access to the most appropriate insurance coverage for their health care needs.

Open enrollment – which takes place between November 1 and December 15 in most states – is the time of year when people with private health insurance or government-sponsored health insurance like the Affordable Care Act have the opportunity to enroll in or change their benefit programs.

“It is critical that pregnant women fully understand their health care benefits, and open enrollment is the perfect time for mothers and expectant mothers to check whether their health insurance plans cover the specific prenatal and maternal needs of their pregnancy,” said Brianna Wetherbe, Director and Board Member of Stand Up for APA. “We strongly believe that all health insurance plans – private and public – need to provide the highest standard of maternal and prenatal care options, including non-invasive prenatal testing (NIPT), to all pregnant women regardless of age or baseline risk.”

Here are the top three questions that all expectant mothers should ask this open enrollment period:

1. How does my plan cover costs related to pregnancy and giving birth? Most maternity costs are detailed in a plan’s Summary of Benefits and Coverage document; make sure to review plan details such as copays, coinsurance rates deductibles, and out-of-pocket maximums to ensure that there are no surprise charges during prenatal and maternal services such as labor and delivery, midwife services, medically prescribed c-sections, or neonatal care.
2. Are my preferred doctors and medical facilities in-network? Check to see if preferred physicians and medical facilities are covered and in-network. Plan details can vary widely if a mother anticipates using infertility treatments, a nurse-midwife, or an independent birth center.
3. What specific services and procedures does the plan include for prenatal and maternity care? Beyond simply reviewing the costs, make sure to carefully review a health plan’s summary of benefits to see the specific set of prenatal and maternal care services it covers. Most plans will cover “essential services” such as delivery and inpatient hospital services, but other services, such as prenatal services, health screenings, lab work, ultrasounds, and birthing classes may not be covered. For example, a few large health insurers such as United Healthcare and Aetna still refuse to fully cover NIPT for all pregnant women, which goes against the guidance of the American College of Obstetricians and Gynecologists (ACOG) and other leading physician organizations.

To learn more about NIPT access and Stand Up for APA, please visit: standup4apa.org.