Yes, all ACA Marketplace health plans are required by law to cover maternity care and pediatric services. These are two of the ten Essential Health Benefits that every plan must include, regardless of the plan tier or carrier.
The ACA's Essential Health Benefit requirements were designed to end the pre-ACA era when pregnancy was often treated as a pre-existing condition and maternity coverage was sold as an expensive add-on, if it was available at all. Today, that coverage is built into every compliant plan from the moment you enroll.
Maternity and newborn care coverage includes prenatal visits, labor and delivery (both vaginal and C-section), and postpartum care for the mother. Newborn care covers the baby's care in the hospital, and your newborn can be added to your plan within 30 days of birth, with coverage backdated to the birth date.
Pediatric services for children include:
- Annual well-child checkups
- Recommended vaccinations and immunizations
- Dental care (exams, cleanings, and basic treatment)
- Vision care (exams and one pair of corrective lenses per year)
- Developmental screenings
Keep in mind that "covered" and "free" are not always the same thing. Your deductible and cost-sharing apply to most maternity and pediatric services. Preventive services like well-child visits and recommended vaccines are covered at $0 under most plans, but a hospital delivery will typically count toward your deductible. If you're planning a pregnancy, choosing the right plan tier ahead of time can significantly reduce what you'll pay out of pocket.
Want help finding a plan with strong maternity or pediatric coverage that fits your budget? Call us at (305) 330-1277 or Find a plan that fits your family.
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