Expecting or adopting a baby? Congratulations! Bringing a baby into your family can be the most exciting and meaningful time in your life.
In the excitement, don’t lose sight of your baby’s health insurance.
While you’ll have a grace period, you must act quickly to add your baby to your plan, or get them their own coverage.
What You Need to Know
While many employer plans automatically cover newborns for 14 days as part of the mother’s coverage, you must formally add the baby to your plan within 30 or 60 days, depending on the type of insurance. If you and your spouse or partner each have coverage, you’ll need to decide which of you will cover your child.
Having a baby is a qualifying life event, which means you can switch health plans to find a better match for your growing family, or change coverage tiers (for example, from self only to self + child).
Be prepared. You’ll need your baby’s birth certificate and Social Security number to prove they’re eligible for your plan.
What Do You Need to Do Before Your Baby Is Born?
While you’re preparing for your baby to arrive, review the costs and benefits of your current health insurance and compare them to other plans and options (such as your spouse’s or partner’s plan). If you find a better option, reach out to the new insurer to make the switch after your baby is born.
If you have other children, it may not cost you more to add the newborn.
Maternity and newborn care are part of the essential health benefits required by the Affordable Care Act.
Does Health Insurance Cover Newborns?
If you have an employer-based plan
If you have insurance through an employer, your baby will be automatically covered for a set period immediately after birth. Notify your insurer, or your human resources or benefits department, within 30 days of the baby’s arrival to add them onto the insurance plan.
Your baby will be enrolled retroactively as of their birth date and can’t be rejected for preexisting conditions. Any medical care they get in those early days will be covered if you sign up in time, even for services received before you signed up.
Some employers offer extra time to enroll a newborn. Check your company’s rules.
If you and/or your dependents are covered under Medicaid or a state Child Health Insurance Program (CHIP) but lose eligibility for that coverage, you have up to 60 days from the date you lose coverage to enroll in your employer’s plan.
During the Covid-19 pandemic, the U.S. Department of Labor and the Internal Revenue Service (IRS) published a rule1 waiving certain timeframes, such as the deadlines for enrolling a newborn on a group health insurance plan. The rule will last until 60 days after the national public health emergency ends, or until a date determined by federal agencies.
The pandemic conditions are ever-changing, so check the current rules. That way, you know how long you have to add your baby to your health plan.
If you have an individual or Exchange plan
If you’re enrolled in an individual coverage plan, or you have a federal or state Health Insurance Marketplace plan, you have 60 days to add your baby to your plan.
For hospital stays
In addition to prenatal visits and routine screenings during pregnancy, insurers must cover hospitalization for both parent and newborn for 48 hours following a vaginal delivery and 96 hours following a cesarean section delivery. If the parent or baby needs more time, the insurance company typically must approve an extension. This process is called prior authorization.4
You may be entitled to additional benefits
Depending on your plan type (for instance, an HMO or PPO), you might be entitled to additional benefits for yourself or your baby. Many large insurers have special maternity programs (though you’ll have to sign up during your pregnancy) that offer coaching, support and additional resources. Other insurers offer extra benefits like covering prenatal classes or newborn car seats.
All insurers must cover breastfeeding support and breast pumps,5 but the specifics of what you can get vary by plan.
Do some research before the baby is born about what your health plan offers and sign up for any special programs for pregnancy and/or newborn care.
Coverage During Special Situations
There are options for covering your baby even in special situations, such as losing your job.
What If You Don’t Have Health Insurance?
If you don’t have health insurance, now is the time to get it. You’ll need coverage for the baby’s delivery and for frequent newborn checkups.
Medicaid and the Children’s Health Insurance Program (CHIP)
Medicaid and the Children’s Health Insurance Program (CHIP)6 are insurance programs for low-income people, including pregnant women and children. Medicaid eligibility and program rules vary by state. Check with your state to see if you qualify for free or low-cost coverage. Some people on Medicaid pay a small portion of costs, while others pay nothing at all.
CHIP covers children whose families earn too much to qualify for Medicaid and, in some states, lower-income pregnant women.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
If you or your spouse or partner recently lost their job at a company with at least 20 employees, you’re likely eligible for coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA).7
With COBRA, you can buy your former employer’s health insurance at full price for 18 months8 after you’ve left the job. COBRA tends to be very expensive because the employer no longer pays any part of your premiums. But if you’re about to have a baby and you don’t have other options, COBRA may help in the short term. Check with your former employer for details about costs and the process for getting covered.
Qualified Medical Child Support Orders
Qualified Medical Child Support Orders (QMCSOs)9 are court or state-agency orders that require a child to be covered on a group health plan. For example, a child or stepchild may be able to access a parent’s health insurance through one of these orders.
Some states, such as California, Massachusetts, Vermont and Rhode Island, as well as the District of Columbia, require every resident including newborns to have health insurance coverage. Your state may offer special coverage options. Find out the specific rules and coverage options where you live.
Can You Buy Health Insurance Just for Your Newborn?
Child-only health plans may make sense in certain situations. You may have employer-sponsored insurance with no option to include children, or you may qualify for Medicare, which doesn’t offer dependent coverage.
If you need a child-only plan and don’t qualify for Medicaid or CHIP, visit the federal or state Marketplace. Depending on your income, you may qualify for subsidies.
You may be able to buy a child-only plan directly from an insurance company, though it will likely cost more if it’s available.
In your search for options, beware of short-term and catastrophic plans, which may not include coverage for maternity care or for newborns.
While You Wait for Baby
While preparing for your newborn’s arrival, research your maternity and newborn benefits. Check your plan’s Summary Plan Description (SPD) and Summary of Benefits and Coverage (SBC) documents, or call your insurer. If you and your spouse/partner each have coverage through your employer, compare plans to see which makes the most sense for your family.
You may also want to check your state’s maternity and newborn coverage rules, which you can find through the National Association of Insurance Commissioners.10
Reach out to your company contact or your health insurer to add your baby to your coverage, and notify them within 30 days of birth, adoption, or placement for adoption. If you have or switch to a Marketplace plan, you’ll have 60 days from the date of birth or adoption.
Then get all the sleep you can before the baby arrives.