When you are expecting a child, there are many things that might be on your mind during your pregnancy. One of those concerns could be healthcare coverage for your baby. Fortunately, this is one concern you may put to rest.
If you have your own healthcare plan, you and your child will have coverage immediately following birth. If you or your spouse have health insurance through an employer, you will be able to change your plan right away, since having a child is a qualifying life event that triggers a special enrollment period. That special enrollment period also allows you to enroll in a plan to get the coverage you and your baby need.
If you are looking to find a family health insurance plan or need help figuring out which type of health plan is right for you, eHealth is here for you. Compare affordable plans in your area with our comparison tool or speak to a licensed agent online or over the phone today.
How does health insurance work for newborn babies?
Insurance for a newborn works just like insurance for you. The baby is on a policy, and the insurance will cover all or a portion of the baby’s healthcare. And just like you’re on health insurance policy, you’ll have co-pays, deductibles, etc.
Bear in mind that just because you had health insurance during pregnancy doesn’t mean your coverage is automatically extended to your newborn. Fortunately, whether you have work-based coverage, private insurance, or an Affordable Care Act (ACA) plan, a baby is considered to be a life event, so you may add him or her to your plan.
At this point, because you’re in a special enrollment period, you’ll be able to change your plan or purchase new coverage. You might also be eligible for a plan that’s lower in cost due to this change.
Why is it important to have health insurance for newborns?
Adding a newborn to your insurance or creating a new policy for your little one will decrease the amount of out-of-pocket expenses you’ll pay for them. For one, as soon as your baby is born, there are certain tests and vaccinations given. After you take your baby home, you’ll also want health insurance for a newborn to cover the expenses of wellness visits. You bring a newborn baby to the doctor a lot during their first year of life, so you definitely want health insurance to cover that.
Once your baby is one year old, it’s recommended your child visit the pediatrician once per year. This is to ensure your baby is growing normally and to keep them up-to-date on his or her immunizations.
Keep in mind that if your tot has any issues, you’ll have the added expense of extra appointments. Not to mention, you may need to meet with specialists, and your little one may need to undergo certain procedures or take medications. All of these appointments and immunizations can quickly amount to a lot, but health insurance can help to significantly reduce these costs.
What benefits are typically covered for newborns under health insurance?
Under most health insurance plans, a range of essential benefits is typically covered for newborns. These services are crucial for ensuring the health and well-being of the baby during the early stages of life. Commonly covered services include:
- Well-Baby Checkups: Regular well-baby visits to the pediatrician are covered. These checkups are vital for monitoring the baby’s growth and development and typically include measurements, physical examinations, and developmental screenings.
- Vaccinations: Immunizations are a key component of newborn care. Health insurance plans generally cover the cost of recommended vaccines, which are crucial for protecting the baby from various infectious diseases.
- Hospitalization: If a newborn requires hospitalization after birth, whether for routine care in the case of a normal delivery or for more intensive care such as in a neonatal intensive care unit (NICU), these hospital stays are typically covered. This includes both the care received by the baby and any related hospital charges.
- Emergency Care: In the event of an emergency, health insurance plans provide coverage for urgent medical attention required by the newborn. This can include emergency room visits, diagnostic tests, and treatments provided during these critical situations.
- Specialist Care: If the newborn needs to see a specialist, such as a pediatric cardiologist or endocrinologist, these visits are usually covered under health insurance plans. Referrals from a primary care physician may be necessary depending on the plan’s requirements.
- Prescription Medications: Medications prescribed for the newborn, whether for routine or specialized conditions, are typically covered. The extent of coverage can vary based on the plan’s formulary.
It’s important to note that the specifics of what is covered and the extent of coverage can vary depending on the health insurance plan. Parents should review their health insurance policy details or contact their insurance provider to understand the full range of benefits available for their newborn. Additionally, parents should ensure that their newborn is added to their health insurance policy within the required timeframe after birth to ensure continuous coverage.
Types of health insurance plans for newborns
When it comes to selecting health insurance for newborns, parents have several options to consider, each offering different levels of coverage and benefits. Employer-sponsored plans, provided through a parent’s workplace, are a common choice and often include comprehensive coverage for family members, including newborns. Government programs like Medicaid and the Children’s Health Insurance Program (CHIP) offer an alternative for families with limited income or special circ*mstances, providing essential healthcare coverage for children at little to no cost. Additionally, individual health insurance plans, available through the health insurance marketplace, can be tailored to include newborns, offering a range of coverage options to suit various healthcare needs and budgets. Each of these options has its own eligibility criteria, benefits, and enrollment processes, making it important for parents to carefully assess which type of plan best aligns with their family’s healthcare requirements and financial situation.
Overview of individual policies and family plans
When choosing health insurance coverage for newborns, parents typically consider two main types of plans: individual policies and family plans. Individual policies, purchased by an individual either through an employer or the health insurance marketplace, offer customizable coverage options for the policyholder and their dependents, including newborns. These plans allow for a tailored approach to healthcare, selecting different levels of coverage, deductibles, and premium costs. However, adding a newborn to an individual policy may increase the premium.
On the other hand, family plans are designed to cover the entire family, including newborns, under one policy. Available through employers or the marketplace, they generally have higher premiums than individual policies but can be more economical than separate policies for each family member. Family plans typically include a range of healthcare services suitable for all ages, offering a comprehensive approach to family healthcare needs. They usually feature a shared deductible and out-of-pocket maximum, streamlining healthcare expense management.
Both plan types encompass essential benefits like preventive care and pediatric services, mandated by the ACA. In deciding between these options, factors like cost, coverage level, provider network, and specific healthcare needs should be carefully weighed, keeping in mind the enrollment periods and requirements for adding a newborn to an existing policy.
Government programs for newborns: CHIP and Medicaid
Government programs play a pivotal role in providing financial assistance for newborn coverage, especially for families facing affordability challenges. Medicaid and the Children’s Health Insurance Program (CHIP) are key government initiatives designed to support families with newborn health coverage. You have options before giving birth if you are having a difficult time affording health insurance. Even if you don’t think you qualify based on income for programs like Medicaid, you should still apply because you may be more likely to receive coverage if you are pregnant. With Medicaid, you don’t have to wait until the annual open enrollment period to apply and enroll; you can enroll in coverage at any time of the year if you qualify.
Additionally, there are facilities – such as Planned Parenthood – that sometimes offer prenatal care at lower- rates depending on your income.
Medicaid, a state and federally funded program, offers comprehensive healthcare coverage, including prenatal, delivery, and postnatal care. For example:
- Medicaid offers comprehensive health coverage for low-income families and is particularly accessible for pregnant women and newborns.
- Eligibility for Medicaid often extends to a broader range of income levels for pregnant women, making it a viable option for expectant mothers who might not typically qualify.
- One of the significant benefits of Medicaid is that there is no restricted enrollment period. Eligible individuals can apply and enroll at any time of the year, providing essential health coverage for both the mother and the newborn.
- Post-birth, Medicaid coverage for the newborn can often continue, ensuring the baby has access to vital healthcare services such as well-baby visits, vaccinations, and any necessary medical treatments.
If you don’t have health insurance and aren’t planning on getting health insurance, you can look into applying for CHIP. The Children’s Health Insurance Program (CHIP) is a way to get health insurance for families who have a difficult time affording health insurance for themselves or health insurance for babies or older children.
While CHIP coverage varies state to state, CHIP provides coverage for the following services in all states:
- Check-ups
- Immunizations
- Doctor visits
- Prescriptions
- Dental and vision care (which are ordinarily covered through a parent’s health insurance)
- Inpatient and outpatient care
- Laboratory and X-ray services
- Emergency services
Keep in mind that in some states CHIP may provide more covered benefits for your child. The eligibility guidelines for CHIP vary from state to state, but like Medicaid, you can enroll at any time.
How to add a newborn to your existing health insurance
Your baby won’t automatically become a part of your policy. Fortunately, learning how to get insurance for a newborn is rather simple.. You just need to contact your insurance provider once you have the baby to add him or her to the plan. If you went through a work insurance company, you can add a newborn to your insurance by simply reaching out to your work’s HR department.
As a general rule, your provider will require you to add your baby within 30 to 60 days after his or her birth. The policy is retroactive, meaning it’ll cover your child’s care going back to birth, so don’t panic if you’re a tired parent and your child is now three weeks old with no insurance.
Timeline for adding a newborn to your health insurance
After your baby is born, your child is covered for the first 30 days of life as an extension of you, the mother, under your policy and deductible.
Starting on day 31, this extension of coverage ends. While maternity care (both pre and postnatal) and some health care services for children are essential benefits that are covered by all marketplace plans, health insurance for babies is not included as an essential benefit. To get health insurance at this time, you must enroll in or change your health insurance plan.
Enrollment process for newborn health insurance
Having a child is a qualifying life event that triggers a special enrollment period. During the special enrollment period, you can enroll in a plan or change your current plan without waiting for the open enrollment period to begin. The special enrollment period extends for 60 days after your child’s birth. Once enrolled, the effective date is retroactive to your child’s birthdate.
Here’s a more detailed look at the process:
- Special Enrollment Period Activation: The birth of your child activates a 60-day special enrollment period. This timeframe is crucial as it allows you to make changes to your health insurance promptly after your child’s arrival.
- Choosing or Changing a Plan: During this 60-day period, you can choose a new health insurance plan or modify your current one to include your newborn. This can be done through your employer (if you have employer-sponsored insurance), directly with your insurance company, or through the health insurance marketplace.
- Documentation and Application: You’ll typically need to provide documentation of the birth, such as a birth certificate or hospital records, as part of the enrollment process. Completing an application with the necessary personal information about your child is also a requisite step.
- Coverage Effective Date: Once you enroll, the coverage for your newborn is retroactively effective from the date of birth. This means that any medical care your child receives from birth onwards will be covered under the new policy.
- Processing Time: Be aware that while the coverage is retroactive, processing the enrollment can take some time. It’s advisable to initiate the enrollment process as soon as possible after your child’s birth.
- Assistance and Guidance: If you need help or have questions during this process, you can seek assistance from insurance brokers, your employer’s human resources department, or customer service representatives from the insurance marketplace or your insurance provider.
By understanding and utilizing the special enrollment period, you can ensure that your newborn’s health insurance coverage is in place promptly, providing essential health protection from the very beginning of their life.
What to do before your baby is born
Whenever you’re going to get health insurance for kids, it’s important to compare policies because adding your child to your current plant isn’t always the cheapest, and it might not provide adequate benefits. Therefore, make sure you see how much it would be to add your child to your policy. You may also create a child-only health insurance policy through another company without having to put yourself on the plan.
Understanding a few tidbits of information about insurance for newborns or adding a newborn to your current policy can help you make a financially sound decision about your little one’s healthcare.
Frequently asked questions about health insurance for newborns
What are the risks of not having newborn coverage after the first 30 days of birth?
According to Medibank, health care services for newborns are among the most expensive medical expenses. According to Parents.com, birth can cost between $2,000-$4,500 dollars depending on the method of delivery without complications. You would not only have to pay for prenatal, delivery, and postnatal care out-of-pocket, but for all care that your newborn receives after birth.
Without insurance coverage, you could end up with expensive medical bills that can create a financial strain on your growing family. Getting newborn coverage in the first 30 days will help you protect both you and your baby.
If you need to find a plan for your newborn, eHealth’s services are free to consumers and we offer dedicated support teams to help you manage your plan throughout the year. We offer 24/7 support and the ability to purchase plans through a phone call, live chat, or our website for your convenience. Click this link to find plans in your state.
How much does health insurance cost for newborns?
The cost of health insurance for newborns can vary based on several factors including the type of plan, geographic location, and specific coverage options. Generally, adding a newborn to a health insurance plan will increase the premium, but the exact amount depends on the insurance provider and the existing plan. Some plans may offer coverage for newborns at no additional cost for a certain period of time, while others may require an increase in premium immediately upon adding the newborn. It’s advisable to check with your insurance provider to get a precise estimate of how much your premium will change with the addition of a newborn.
Can I change my health insurance plan after adding my newborn?
The birth of a child is considered a qualifying life event, which triggers a special enrollment period (SEP). This period allows you to make changes to your health insurance plan outside of the regular open enrollment period. Here are some key points to keep in mind:
- Special Enrollment Period: You have a 60-day window starting from the date of your child’s birth to change your health insurance plan. This time frame is crucial for making any necessary adjustments to your coverage.
- Plan Options: During the SEP, you can switch to a different plan that better suits your new family situation. This could mean moving to a plan with more comprehensive coverage, a larger network of pediatricians, or lower out-of-pocket costs.
- Coverage Effective Date: If you change plans after the birth of your child, the new coverage typically starts on the first day of the month following the plan change. However, coverage for your newborn is retroactive to their date of birth.
- Documentation Requirements: Be prepared to provide documentation such as a birth certificate or proof of birth from the hospital when you apply for a plan change. This documentation is necessary to confirm the qualifying event.
- Employer-Sponsored Insurance: If your insurance is through your employer, inform your HR department about the birth of your child and discuss your options for changing plans.
- Marketplace Plans: If you have a plan through the health insurance marketplace, you can update your application to reflect your change in family size and explore different plan options.
- Considerations for Plan Change: When choosing a new plan, consider factors like premium costs, deductibles, copays, coverage details, and the network of providers, especially pediatricians and childcare specialists.
- Impact on Premiums and Subsidies: Adding a child to your policy or changing plans can affect your premiums and eligibility for subsidies. Review these financial aspects carefully to understand how your costs may change.
- Seek Professional Advice: If you’re unsure about the best course of action, consulting with a healthcare insurance professional or broker can provide clarity and help you make an informed decision.
Where should I start shopping for health insurance for babies?
It is a good idea to start looking into health insurance for your newborn before you give birth. You can start looking for individual and family health insurance that will meet your coverage needs with eHealth. eHealth offers access to thousands of affordable plans from major companies across the US to make it easy for you to find the right plan for your needs and budget. eHealth also offers unparalleled support from licensed agents to answer any questions you may have about newborn health insurance.
