Health insurance coverage for a newborn is easily available and is quite affordable, since children's rates are based on the age of the applicant. Many of the largest companies offer policies that can be applied for in minutes, and quickly approved. Adding to an existing Group plan is also possible. If eligible for CHIP benefits, office visit copays and the premium will be very low, and a private or group plan will not need to be purchased. Prenatal and postnatal maternity care is a covered "essential Benefit" Marketplace benefit.
We help you find quality medical benefits for your baby at the lowest possible price. A federal subsidy can reduce Marketplace plan rates below $20 per month, and allow you to immediately enroll with pre-existing conditions covered. Child-only plans are offered if the parents do not need coverage. Infant policies are also available in all states along with options for pregnant and soon-to-be pregnant mothers.
Private and Group coverage also covers labor and delivery of newborns. Adopted children can also easily obtain coverage. Newborn insurance coverage for the first 30 days is often the most critical time to have benefits. Private and Group plans generally do not provide benefits during this time period. However, the Mother's policy can be utilized for up to 31 days. An individual policy, if needed, generally costs less than $150 per month, and much less with a large federal subsidy.
Having a baby is considered a "qualifying life event," which is considered a major change in life circumstances. Thus, once you give birth, a period of up to 60 days is available to obtain mandated health insurance benefits, regardless of any existing medical conditions. If you have current coverage, you may add your boy or girl to the existing policy. Needed treatment can be covered immediately. Pending surgeries or procedures would also be covered without a waiting period or surcharge. CHIP is also offered to families that earn incomes too high to qualify for Medicaid. Pregnant females can qualify for benefits in selected states. Additional specific details are discussed later in this article.
It's also important to know and understand many of the rights and privileges you have. For example, you can generally expect either an approved two, three, or four-day stay in the hospital, depending on the type of delivery. With most policies, by notifying the insurer within 30 days of birth, benefits will become retroactive to the actual date of birth. NOTE: The expectant mother is entitled to specific benefits under most plans such as breast-feeding supplies, lactate consulting, and related rental of equipment. If the policy is HSA-eligible, additional expenses may be tax-deductible, include prescription drugs.
Postpartum depression is also a covered condition that will not be excluded. Therapy and prescription drugs are included in benefits, along with several nursing and feeding expenses. Often, treatment includes counseling and antidepressant medications. Milder cases may be able to be treated without prescription drugs. Breastfeeding will probably not be interrupted with some antidepressants. Your primary care physician can provide the most appropriate treatment, and if needed, prescribe medication. Generic, non-generic, preferred brand, non-preferred brand, and specialty drugs are covered on all Exchange plans (and Senior Medicare plans).
Expansion of Medicaid in many states has improved access to treatment. Currently, most states have adopted the expansion of Medicaid, and have also begun to implement the changes. The only states that have not yet expanded are North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Texas, Kansas, South Dakota, Tennessee, Wyoming, and Wisconsin. A Section 1115 Waiver allows states to operate their Medicaid program differently than current federal legislation. The states granted this exemption are Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, New Hampshire, New Mexico, Ohio, and Utah.
Adding A Child To Your Existing Plan
The easiest way to cover your new addition is to add them to an existing policy. Preferably, your own. The average monthly cost tends to be low, and most policies either cover your newborn immediately, or when the baby has been released from doctor's care. However, if you are presently covered on a non-compliant policy (limited benefit or temporary contract), you likely will not be able to add additional family members without submitting a new application. Since the policy will be medically-underwritten, benefits will not start immediately, and any new medical issues will be excluded from the new policy. (Medicaid and CHIP will cover pre-existing conditions)
Most consumers are not familiar with the carriers that issue and underwrite "non-compliant" plans. Short-term contracts, although quite inexpensive, may require newborns to apply for separate coverage. Also, you can purchase healthcare coverage for your baby (only). In many households, the cost of adding dependents to an employer-provided plan may be quite expensive. Private coverage can provide a lower rate, although a federal subsidy may not be offered since group benefits are available. CHIP and Medicaid may also be available, depending upon your household income. Benefits are very robust, although not all local hospitals will be in the provider network.
Child-only coverage is also offered on and off-Exchange. Most pediatric expenses are covered, although a copay or deductible may apply to non-pcp claims. To cover specialists, ER, and Urgent Care expenses without a deductible, often a Gold or Platinum-tier plan will have to be selected. Silver-tier plans that qualify for cost-sharing will feature lower out-of-pocket expenses. Deductibles can reduce from $8,550 to less than $2,000 while office visit copays (both pcp and specialist) also are lowered. Urgent Care and ER copays can also reduce. Online telemed visits often have little or no copay and unlimited usage is a common provision.
If you have recently enrolled in a Marketplace (Obamacare) policy from a state or federal Exchange, the birth of a child qualifies for a "Special Enrollment Period (SEP). Thus, regardless if the Open Enrollment period is current, or has already ended, you can purchase coverage without answering medical questions, qualify for a subsidy (if applicable), and have all pre-existing conditions covered. This includes medications, pending surgeries, diagnostic tests and well-check visits. Life-threatening juvenile illnesses are also covered, such as diabetes, cerebral palsy, sickle cell anemia, cystic fibrosis, cancer, AIDS, and epilepsy. The coronavirus was covered in 2020 and 2021.
Infant life insurance can also be purchased, although the rate may be higher if there are existing serious illnesses, and a qualifying life event is not granted. State or federal options may be offered depending on the Federal Poverty Level (FPL) of the household. Dependents can generally be added to Group plans during their Open Enrollment period. However, a separate plan generally is not issued, so the new benefits match the employee's coverage. When the dependent reaches age 26, a separate policy will likely be required. The cost of coverage is inexpensive, since most applicants have no major health conditions.
A newborn, of course, will increase your premium, but not substantially. In many Midwestern states, the monthly increase may be as little as $25-$65 per month. In other areas, the premium could be higher. If you already have dependents covered under your own plan, it's possible that there will be little or no change in your monthly cost, since certain policies charge the same amount once you exceed two dependents. And adding a dependent could could possibly result in a larger subsidy. NOTE: It is also possible that adding a son or daughter to your policy could suddenly make you Medicaid-eligible, and therefore risking loss or a reduction of a federal subsidy.
Cost Of Adding A Newborn To Your Health Insurance Policy
Often, the rate reduces, since the amount of the federal subsidy exceeds the cost of adding your new son or daughter. Examples from different areas are illustrated below. Monthly premiums are based on a married couple (both age 30) with household income of $40,000, adding a newborn to the policy. A popular Silver-tier plan is utilized. CHIP/Medicaid coverage may be required for newborn.
Pittsburgh, PA. Highmark Together Blue EPO Extra Savings Silver 1050
$232 -- Monthly Rate For Husband And Wife
$168 -- Monthly Rate For Husband, Wife, And Newborn
Cincinnati, OH. Ambetter Balanced Care 29
$255 -- Monthly Rate For Husband And Wife
$191 -- Monthly Rate For Husband, Wife, And Newborn
Charlotte, NC. Bright Silver 3800
$253 -- Monthly Rate For Husband And Wife
$194 -- Monthly Rate For Husband, Wife, And Newborn
Indianapolis, IN. CareSource Marketplace Low Premium Silver 1
$256 -- Monthly Rate For Husband And Wife
$192 -- Monthly Rate For Husband, Wife, And Newborn
Chicago, IL. Bright Health 3800
$242 -- Monthly Rate For Husband And Wife
$178 -- Monthly Rate For Husband, Wife, And Newborn
Milwaukee, WI. Together Silver 200
$245 -- Monthly Rate For Husband And Wife
$181 -- Monthly Rate For Husband, Wife, And Newborn
St. Louis, MO. Cigna Connect 2500-2
$254 -- Monthly Rate For Husband And Wife
$190 -- Monthly Rate For Husband, Wife, And Newborn
Houston, TX. myBlue Health Silver 405
$238 -- Monthly Rate For Husband And Wife
$174 -- Monthly Rate For Husband, Wife, And Newborn
Phoenix, AZ. Oscar Silver Saver 2 CSR 250
$239 -- Monthly Rate For Husband And Wife
$175 -- Monthly Rate For Husband, Wife, And Newborn
Atlanta, Ga. Anthem Silver Pathway X Guided Access HMO 6250
$243 -- Monthly Rate For Husband And Wife
$180 -- Monthly Rate For Husband, Wife, And Newborn
Omaha, NE. Medica with CHI Health Silver Copay
$248 -- Monthly Rate For Husband And Wife
$184 -- Monthly Rate For Husband, Wife, And Newborn
Kansas City, MO. Ambetter Balanced Care 29
$228 -- Monthly Rate For Husband And Wife
$164 -- Monthly Rate For Husband, Wife, And Newborn
Oakland, CA. Kaiser Silver 73 HMO
$129 -- Monthly Rate For Husband And Wife
$77 -- Monthly Rate For Husband, Wife, And Newborn
Oklahoma City, OK. Bright Health Silver 3800
$233 -- Monthly Rate For Husband And Wife
$170 -- Monthly Rate For Husband, Wife, And Newborn
Purchasing A Marketplace Policy
You can purchase an individual private policy through a state or federal Marketplace. Because premiums are based on age (among other factors), you won't have to pay a high rate. Although Open Enrollment periods (under The Affordable Care Act) begin in November, special circumstances will allow you to apply for coverage if specific events occur. Coverage is guaranteed, pre-existing medical conditions are covered, and all available plans in your area will be offered. Pediatric dental and vision benefits are typically included on qualified plans. Preventative visits often are provided without out-of-pocket costs.
Stand-alone dental and vision options may be offered for adults. Monthly rates typically vary between $10 and $40 per month. Major carriers, including Humana, Blue Cross, and Aetna, offer a wide selection of plan options. Preventative visits, including x-rays and routine visits are usually covered with no out-of-pocket expenses. Major procedures may have a waiting period and limitations of benefits. Delta Dental and MetLife offer popular dental plans through employer payroll-deduction. However, individual private plans are not offered, except to retirees of these companies.
The birth of a child is one of those events (mentioned earlier). If you move to a different service area, get divorced, or lose qualified benefits from your employer, you can also obtain Marketplace coverage. For 2021, Open Enrollment began on November 1st (ending December 15th). Many states feature new carriers, including some companies, who have increased the number of states where they offer policies. However, several major companies have begun to reduce their areas of coverage. Aetna previously offered on-Exchange contracts in four states, while UnitedHeathcare has previously exited all Exchanges, only to return to several states this year.
Humana and Cigna continue to specialize in Senior and Group products, instead of under-65 plans. Cigna reduced the number of states where they offer plans, and Humana exited all states. Oscar and Ambetter have increased their coverage area, especially in Pennsylvania. In recent years, Blue Cross and affiliated companies have increased the number of counties where they offer coverage. Anthem Blue Cross returned to Indiana this year, and offers plan in several counties. Kaiser, another major insurer, has concentrated primarily on employer-provided plans.
Each year, new plans offer richer and more comprehensive benefits (prenatal and adolescent) while premiums occasionally reduce, instead of becoming more costly. Although many states often have substantial rate increases, children and toddler premiums generally do not increase as fast. With the passage of the Affordable Care Act (Obamacare) legislation, baby benefits cover all pre-existing conditions and all needed preventive pediatric expenses. As the newborns become children, and eventually adults, benefits change to continue to provide comprehensive coverage. Young adult health insurance coverage is offered in every state, and prices continue to remain fairly low.
This includes include well-child visits, immunizations and approved vaccines (Hepatitis A and B, Influenza, Meningococcal, Varicella and many others). Overall, as your baby gets older, more than 25 specific treatments for children must be covered. The US National Library of Medicine is also a valuable resource for providing information regarding health topics, drugs, and supplements, and educational videos. Listed below are several of the services that can be used in the earlier years:
Screening for autism between the ages of 1 1/2 and 2
Behavioral assessments for the following ages: 0-11 months, 1-4 years, 5-10 years, 11-14 years, and 15-17 years.
Blood pressure screening
Depression screening for adolescents
Developmental screening (Under age 3)
BMI (Height and Weight) and blood pressure screening at most ages
Hearing and vision screening
Sickle cell and Hemoglobinopathies screening
HIV screening for high-risk adolescents
Iron supplements (for increased anemia risk)
PKU and obesity screening
Oral risk assessment
Gonorrhea medication for newborns
Alcohol and drug addiction assessments for older children.
Federal Subsidies Through The Exchanges
A federal subsidy can easily pay most of your premium, depending on your Adjusted Gross Income (AGI). If your income is too high, you may be ineligible to receive a subsidy, which is applied to your rate as an immediate tax-credit. If your income is too low, you also may be ineligible for financial aid, although CHIP or Medicaid will likely be offered.
Any sudden changes in income or employment may trigger changes. You can contact us to review what ramifications (if any) these changes will have on your medical benefits. The most significant changes occur if you or a family member suddenly become eligible for Medicare, Medicaid or CHIP. It's also possible that other family members may also be impacted by your change in eligibility.
Using Milwaukee as an example, If the household income for yourself, your husband (both age 30) and your child is approximately $95,000, you will not qualify for a monthly subsidy to assist paying your premium. However, if your income is only $75,000, the subsidy amount becomes $538 per month. Utilizing this example, if the household consisted of four persons ( two adults and two children) with an income of $85,000, the subsidy would be $781 per month.
NOTE: To qualify for financial aid, you must enroll in a Marketplace (Exchange) plan. "Off-Marketplace" policies, such as temporary and limited-benefit contracts are not eligible for any subsidy funds. Catastrophic-tier policies are also not eligible, and often place deductibles on specialist visits and most prescriptions. Maximum out-of-pocket expenses are typically $8,550.
Therefore, whether the birth occurs in January, June or December, coverage for the baby can be purchased. Medical issues (if there are any) no longer have any impact on the price you pay for a policy. One of the main concerns is finding a large reputable insurer that offers a contract with all of your network providers included. Typically, Aetna, Blue Cross, Humana, Cigna, Kaiser, and UnitedHealthcare offer the most competitively-priced products with large countrywide provider networks. However, depending upon where you reside, you may have to consider other Exchange carriers, such as Ambetter, Molina, or UPMC. Also, not all large insurers offer Marketplace plans.
We help find the proper fit since each state has a different set of participating insurers. Although Obamacare has lowered premiums for many Americans, it has also reduced the number of companies that offer a policy. While some states offer many carrier choices (Wisconsin -- 13, New York -- 12, California -- 11, and Texas -- 10)), smaller states often only have a few carriers to choose from. For example, Delaware has only one participating carrier offering Exchange plans and Alabama, Alaska, Connecticut, DC, Hawaii, Mississippi, Nebraska, Rhode Island, South Dakota, Vermont, West Virginia, and Wyoming have two.
CHIP And Medicaid
You may also be eligible for Medicaid, or your newborn may be eligible for special government assistance. States are permitted to create their own programs, although federal guidelines must be met. More than 50% of kids in low-income households qualify, so it is a viable option to consider. If the total family income is under $45,000, there's a very good chance that Medicaid or CHIP (Children's Health Insurance Program) will be available. Benefits are very comprehensive, including 100% coverage on most preventative expenses. The network of available physicians is fairly robust, and out-of-pocket expenses are lower than most Bronze and Silver-tier options.
Several of CHIP benefits include emergency services, lab tests and x-rays, inpatient and outpatient surgery, dental and vision coverage, prescriptions, primary-care physician and specialist office visits, immunizations, and routine physicals. Applicants that are eligible for CHIP or Medicaid benefits can also choose to enroll in an Exchange plan, which has guaranteed coverage. However, a federal subsidy may not be offered, which could substantially increase the premium. As household income changes, often eligibility changes for government programs.
Many states have either expanded Medicaid eligibility, or are considering legislation to expand. If approved, depending on the size of the state, hundreds of thousands of persons can become eligible, as the Federal Poverty Level guidelines "expand" from 100% to 138% of FPL household income. When Ohio expanded their program, more than 300,000 persons became eligible to qualify for these benefits. Thus, instead of being forced to purchase a plan that would cost as much as $500-$1,000 per month for the entire family, the "premium" dropped below $50. That's a pretty good deal! Each year, income requirements must be re-calculated, and it is possible that a higher household income may impact eligibility.
Also, Medicaid Expansion States are required to provide the EPSDT (Early and Periodic Screening, Diagnostic, and Treatment Services) to adolescents and children. Low-income infants and children can receive comprehensive diagnostic treatment from qualified physicians. Mandated by the Social Security Act, the benefit stresses early care and protection, so later treatment is minimized or eliminated.
Infants that have mothers already enrolled in Medicaid should be immediately eligible for CHIP. If a child has not had his/her 6th birthday, and the family income is under $30,000, once again, CHIP may be offered. The coverage is very comprehensive and is known as "EPSDT," which is the shortened version of early periodic screening, diagnosis and treatment. Federal funding is expected to continue for CHIP for many more years (and hopefully beyond). If the ACA Legislation is ever altered or repealed, EPSD should not be impacted.
NOTE: States that operate their own Marketplaces also offer CHIP. Typically, CHIP benefits are very extensive. When separate state options include Secretary-approved coverage, benchmark-equivalent coverage, and standard benchmark coverage. Regular benchmark benefits are very similar to HMO plans, State Employee plans, and Federal Employees Health Benefit plans.
You also are protected by The Newborn Act." Under Newborns' and Mothers' Health Protection Act (NMHPA), if you have medical coverage, you are entitled to at least 48 hours of hospital benefits if the delivery is vaginal. If cesarean, the minimum amount of covered benefit is four days. Pre-authorization is not necessary when there is a two or four-day stay in the hospital. However, you are required to stay the full time-period if required by the treating physician. Any attempt to leave early may jeopardize benefits.
When a baby is delivered in the hospital, the required time period begins at the time of the delivery. However, the time of admission to the hospital is used if the delivery occurs away from the hospital and the baby is subsequently admitted. Discharges of the infant can also be processed before the 2-4 day period, with the attending physician and mother's approval. This applies to both private and group coverage. A "HIPAA Exemption Election" may be provided to non-Federal government employers that do not buy coverage. The Act provisions always applies to self-insured plans, although several states have created their own version.
The final option is not costly, but it is risky. By self-insuring (going without coverage) and paying for all services in cash, although there are no coverage premiums to pay, an expensive hospital stay will be difficult to immediately pay for. Therefore it is likely, you will inherit a monthly payment obligation that will last for many years. Assuming an outstanding bill of about $10,000, even if it negotiated down to $6,000, it is likely you will need to pay at least $150 per month until the obligation is payed off. A major medical or catastrophic claim would result in a much larger financial obligation. If your current Group or Exchange policy lapses, you may have to wait until the next Open Enrollment period (typically November) to purchase new coverage.
If you remain uninsured, you are not breaking the law. Previously, the federal government began imposing a special tax of 1% of your household income if you remained without coverage. The tax had increased to 2.5% of household income three years ago (or $695 per adult and $347.50 per child, whichever is greater). Thus, a $60,000 income household paid about $1,500 in penalties. However, this tax penalty was repealed two years ago. NOTE: Although Christian Healthcare plans have grown in popularity, not all of these policies meet the ACA guidelines. However, several more-recognized programs are acceptable, including Christian Healthcare Ministries, Medi-Share, and Samaritan Ministries. Each of these alternatives have alcohol-consumption guidelines that can impact your eligibility. Consistent churchgoing may also be required.
Your newborn needs the proper medical attention to start life on the right foot. We help you find affordable health insurance coverage from either a reputable company, the government, or a combination of both. Children's medical plans can provide quality benefits at a very low cost for most consumers. There also is no cap on the amount of benefits paid for the calendar year or during your lifetime. Thus, if a chronic condition requires hundreds of thousands of dollars of treatment, the cost will be paid. Ongoing medications and specialty treatment will continue to be covered.
According to the CDC (Centers For Disease Control And Prevention), the US preterm birth rate fell to its lowest point in almost 20 years. Based on a 37 weeks gestation period, the number of early deliveries is at 11.4%, with a short-term goal of less than 10% within the next five years. But there still is plenty of room for additional improvement since our country ranks in the bottom half of all countries, according to the World Health Association.
The Affordable Care Act (ACA) should continue to help improve the numbers, since women have much better access to free preventive care and maternity benefits. Many Southern states, including Mississippi and Louisiana have bigger challenges since their current preterm birth rates are close to 15%. Increased education and community outreach should help lower the rates. New and improved medical facilities in rural areas should also help.
Guess which states are ranked the best (and worst!) to deliver your baby? According to W-Hub, a popular financial consumer resource, the 10 top-rated states are Alaska, Iowa, Wyoming, Maine, Kentucky, Minnesota, Hawaii, Oregon, North Dakota, and Vermont. The 10 worst-rated states are Mississippi, Pennsylvania, West Virginia, South Carolina, Nevada, New York, Louisiana, Georgia, Alabama, and Arkansas.
Typically, the average cost of delivering a baby is about $11,000 ($15,000 for a C-section). These survey results considered many factors, including hospital and facility charges and costs, quality of medical services received, and availability of local services. Additional variables considered in the research were wages of doctors, nurses, and specialists, number of clinics and pediatricians in the area, and infant mortality rates.