If you are a pregnant woman, recently gave birth, or are a new legal guardian of a child and need to change health insurance coverage, Cover Kansas can help!
All Health Insurance Marketplace® and Medicaid plans cover pregnancy and childbirth. This is true even if your pregnancy begins before your coverage starts.
Maternity care and newborn care — services provided before and after your child is born — are Essential Health Benefits. This means every qualified health plan inside and outside the Marketplace must cover them.
Let’s look at the coverage provided during pregnancy and after the birth of the child.
Prenatal care and maternal medical care are important parts of pregnancy and every baby’s life. Having healthcare coverage and a plan for both you and your baby is important.
If you want to keep your current Marketplace coverage plan and not make a change, you can elect to not report your pregnancy to the Marketplace. When filling out your application for Marketplace coverage, select the “Learn more” link when the site asks if you’re pregnant to read tips to help you best answer this question.
If you report your pregnancy, you may be found eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP) based on your income. If you are eligible for Medicaid or CHIP, your information will be sent to the state agency, and you will not be given the option to keep your current Marketplace plan.
If you keep your Marketplace coverage, be sure to update the application after you give birth to add the baby to the plan or enroll them in coverage through Medicaid or CHIP, if they qualify. This can be done anytime since this is a Qualifying Life Event (QLE) — you do not have to wait for the annual Open Enrollment Period — childbirth qualifies for the Special Enrollment Period.
Medicaid and CHIP provide free or low-cost health coverage to millions of Americans and thousands of Kansans, including some low-income people, families and children, and pregnant women. Eligibility for these programs depends on your household size, income, and citizenship or immigration status.
You can apply for Medicaid or CHIP any time during the year, not just during the annual Open Enrollment Period. This is called a Special Enrollment Period since childbirth is a Qualifying Life Event (QLE).
You can apply 2 ways:
If found eligible during your pregnancy, you’ll be covered for 60 days after you give birth. After 60 days, you may no longer qualify. The state Medicaid or CHIP agency will notify you if your coverage is ending. You can enroll in a Marketplace plan during this time to avoid a break in coverage.
If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage, and they’ll remain eligible for at least a year.
If you need help with the Marketplace or have questions, speak with a Kansas Certified Health Navigator for FREE!
All plans offered on the ACA Marketplaces must provide coverage for 10 Essential Health Benefits (EHB), including maternity care and prescription drugs. Abortion services, however, are explicitly excluded from the list of EHBs that all plans are required to offer. Under federal law, no plan is required to cover abortion. States can enact laws that bar all plans participating in the state Marketplace from covering abortions, which 26 states have done since the ACA was signed into law in 2010. Most state laws include narrow exceptions for women whose pregnancies endanger their life or are the result of rape or incest, but two states (Louisiana and Tennessee) do not provide for any exceptions. The ACA prohibits plans in the state Marketplaces from discriminating against any provider because of “unwillingness” to provide abortions.
In Kansas, the following restrictions on abortion were in effect as of June 28, 2022:
A newborn needs to see the doctor or nurse 6 times before their first birthday. Your baby is growing and changing quickly, so regular visits are important to keep them healthy. The first well-baby visit is 2 to 3 days after coming home from the hospital when the baby is about 3 to 5 days old. After that first visit, babies need to see the doctor or nurse when they’re:
It is important to make sure your baby, yourself, and your family are covered by an insurance plan of your choice through an insurer, Medicaid, or CHIP. It is best to start doctor visits during pregnancy, called prenatal care. If you need to change coverage during or after pregnancy, you can. The plan you choose should cover you and your baby.
Here are some options if you recently had a baby:
Having a baby qualifies you for a Special Enrollment Period. This means you can enroll in or change Marketplace coverage when you give birth and do not need to wait for the Open Enrollment Period. When you enroll in the new plan, your coverage can start the day your baby was born.
You need to apply for coverage within 60 days after your baby’s birth. Your plan can cover you, your baby, and any other household members. It’s very important to have access to healthcare services for both new parents and babies. With Marketplace coverage, you can get preventive benefits, like well-baby visits and well-child visits.
If you already have coverage through the Marketplace, you can keep your current plan and add your baby to your coverage. You do not need to wait for the Open Enrollment Period to make this change in coverage.
If you would prefer to update your plan or change your coverage, you need to update your Marketplace application within 60 days of your baby’s birth. Your coverage options and savings may change.
You can also create a separate enrollment group for your baby and enroll them in any plan for the rest of the year since having a baby qualifies you for a Special Enrollment Period — You won’t be able to change plans, but you can select any plan available to your baby.
If you’re found eligible for Medicaid or CHIP during your pregnancy, you’ll be covered for 60 days after you give birth. After 60 days, you may no longer qualify.
KanCare, the state Medicaid and CHIP agency for Kansas, will notify you if your coverage is ending. You can enroll in a Marketplace plan during this time to avoid a break in coverage.
If you have Medicaid when you give birth, your baby is automatically enrolled in Medicaid coverage, and they will remain eligible for at least a year.
Contact a Certified Health Navigator who can help answer all your questions about health insurance coverage for your baby, essential health benefits, and choosing health coverage from the Marketplace that best meets your needs.
Call us at (866) 826-8375 or find a navigator near you.
