FAIR Health Consumer Access

Coverage for Family Planning, Fertility and Pregnancy Services

Planning when to start a family is a big decision, and getting the care you need is important every step of the way. From getting pregnant when you want to having a healthy baby, there’s a lot to think about. When you’re planning your family, knowing where to turn for insurance benefits can make things easier. This guide will tell you about types of benefits, types of providers and places to give birth. It will also tell you about private, government, low-cost and other ways to save for family planning, fertility and pregnancy services.

Types of Benefits
Family planning benefits include birth control and tests for sexually transmitted infections (STIs). Some other services are breast and cervical cancer tests.

Fertility benefits cover tests and care you get while trying to get pregnant. They include infertility tests, surgery and in vitro fertilization (IVF). They also include egg freezing, drugs and adoption services.

Pregnancy services include prenatal care (care before the baby’s birth). They also include delivery care (care during the baby’s birth) and postpartum care (care after the baby’s birth). Another name for pregnancy services is maternity care. This can include childbirth education classes and breastfeeding support services too.

Types of Providers and Birth Settings
Your pregnancy and newborn care team can include registered nurses, midwives, doctors and physician assistants. There are different types of midwives to think about. Some examples are certified nurse-midwife (CNM), certified midwife (CM) and certified professional midwife (CPM).

Other team members can include doulas and community health workers. Doulas give emotional and physical support during the birth process and/or afterward. Community health workers give support to families in a community.

The place you give birth could be a hospital or a birth center. A birth center is a home-like healthcare facility where midwives help deliver babies. You could also give birth at your own home (home birth) with a midwife.

Private Health Plans
Employer plans. The Affordable Care Act (ACA) ensures that most plans cover family planning, including birth control, at no cost. Fertility benefits aren’t part of the ACA’s basic benefits, but sometimes your employer will offer health insurance with fertility benefits. Check with your HR department. Fertility treatments may only be covered up to a certain dollar amount.

Under the ACA, most employer plans must cover maternity and newborn care. But the coverage varies. Plans will often cover hospital births and sometimes birth centers in certain states. They often won’t cover home births fully, but they may pay for some of the cost. Most plans will cover midwives, though some plans cover more midwifery services than others. Though most plans won’t cover doulas, they might cover care that can be given by a doula. This could be breastfeeding help or childbirth education. Community health workers won’t often be covered but may be covered if they work with a covered provider. Check with your plan to see what it covers and for how long.

Health Insurance Marketplace. If you don’t have health insurance through your job, you can buy it through the Marketplace. Marketplace health plans cover family planning, pregnancy and newborn care. The birth of a child is a qualifying event, which is an event that lets you sign up for coverage outside of an open enrollment period, but being pregnant isn’t a qualifying event. To get prenatal care you’ll need to apply during an open enrollment period. Check with your plan about fertility benefits. Find out more here.

Government Health Plans
Medicaid and the Children’s Health Insurance Program (CHIP). Medicaid and CHIP are health plans for people with low earnings. These plans are offered by the federal and/or state governments. Family planning is covered by Medicaid in all states, but each may have different services covered. Fertility treatments likely won’t be covered by Medicaid, but some states do cover infertility diagnosis costs. If you’re a woman with low earnings, you may be able to get coverage before, during and after pregnancy and birth. If you choose to have a midwife present at your baby’s birth, Medicaid may cover CNMs but not CPMs. However, many states cover home births under Medicaid, and Medicaid will often cover the mother’s care for up to 60 days after the baby is born. Find out more about pregnancy benefits under Medicaid here.

In some states, CHIP will cover pregnancy care and care for your unborn child. Find out in which states CHIP covers these services here. Some states also cover doulas and/or community health workers under their Medicaid programs. The Doula Medicaid Project shows which states cover doula services here.

Medicare. Medicare is insurance for people over 65. But it’s also for younger adults with disabilities or serious kidney disease. Medicare will cover some family planning. It will cover preventive STI tests and breast and cervical cancer screenings. It often won’t cover birth control. If your birth control is used to treat some other health problem, then it might be covered. Medicare will also cover some fertility treatment, but it won’t cover IVF.

People who get pregnant under Medicare are covered for most pregnancy services. This includes prenatal, birth and postpartum care. Medicare covers hospital births and may cover birth centers and home births too. But your baby won’t be covered after he or she is born.

Free or Low-Cost Care
Planned Parenthood Federation of America. Planned Parenthood is a nonprofit group that gives free and low-cost family planning benefits. Some Planned Parenthood Health Centers also offer low-cost maternity care.

Community health centers. Health centers offer free or low-cost healthcare, including birth control and prenatal care. Some also offer doulas. Find a local center here.

Hill-Burton facilities. Under the Hill-Burton Act, Hill-Burton facilities must give free or low-cost healthcare. That includes prenatal care.

Local medical schools: Check out your local medical schools. They might have clinics that offer free or low-cost prenatal care.

Other Ways to Save
Flexible spending accounts (FSA)/health savings accounts (HSA). FSAs and HSAs let you set aside money out of your paycheck pretax. If your employer offers it, an FSA/HSA can help you save for all pregnancy and birth-related services.

Tax deduction. You may be able to deduct some of the costs of your care. This could be true even if the services you want aren’t covered by your health plan. A tax expert can help you figure out if services can be deducted on your taxes. Check out a list of medical expenses that can be deducted here.

Reach out to local support. Some groups may be able to point you toward coverage for services. Look up doula groups, birth centers or childbirth education programs near you to find out more.

Resources
The National Partnership for Women & Families is a nonprofit. It has a Childbirth Connection site with facts on everything from planning pregnancy to giving birth.

Every Mother Counts is a nonprofit that pledges itself to high-quality, fair maternity care.

Our Cost of Giving Birth Tracker can estimate how much it costs to give birth in your state.