The Affordable Care Act And Your Pregnancy: What You Need To Know
The Affordable Care Act (nicknamed Obamacare) sounds great, but there’s a lot of confusion about what moms-to-be really get from the universal healthcare program. From maternity leave to prenatal appointments, we’ve tackled your biggest questions about pregnancy and the ACA.
There are two important things you need to know about the Affordable Health Act: First, it requires all US citizens and legal residents to get basic health insurance by January 1, 2014 — or else pay a tax. Secondly, the new law (which is the biggest piece of healthcare legislation of our time), comes with a series of new benefits and protections that are really important to expectant moms and children.
But what does the law really mean? And how can you make sure you’re getting the most from your provider? “Every insurer and plan is different,” says Amanda Cole, owner of Yummy Mummy, a New York City store and online retailer. So while different plans offer different features, here’s what you can generally expect.
Obamacare is meant to give people better access to preventative care, including lactation support, counseling and breastfeeding equipment. Laurie Gaydos, assistant professor at Emory’s Rollins School of Public Heath (and an expert in Obamacare), says that the law is intended to offer health insurance to nearly all Americans. “The ACA uses a variety of mechanisms, including mandates and subsidies intended to make health insurance more affordable. It also sets new minimum standards for what insurance must cover.”
What do those new mandates look like? For starters, Gaydos says that your current insurance company is required to contact you if they don’t meet the minimum standards set by the ACA. So if they don’t contact you, that means the plan you have meets the new standard — and there’s no need to worry. “If your previous plan is no longer being offered,” she says, “it’s important to understand that you are not required to select a plan from the same insurance company.”
With Obamacare, you have the freedom to shop around for different providers who might be selling insurance for lower prices — which could mean a better deal! “Sites like Heathcare.gov or your state exchange website can help you compare your options, as there may be many other less expensive options than those offered by your current company.”
As of January 1st, a new list of “ten essential benefits” will come as part of your insurance plan — regardless of which package you choose. The key parts of that essentials bundle you need to know about are maternity care, vision and dental care for children, emergency services, pediatric care and hospitalizations.
Maternity care for every woman
One of the most amazing “essentials” to come out of Obamacare is that maternity care is a requirement for every new insurance plan (score!). In the past, maternity care (which is health care that only women need) has been excluded from much of the individual insurance market, with only 12 percent of the plans sold offering maternity coverage. But in 2014, that’s no more. While maternity leave is still contingent on your employer, more than 8.7 million women will have guaranteed access to maternity care from their individual and small group plan providers. Who runs the world? Yep, we do!
Better preventative care — but no changes to prenatal care
As of 2012, all preventative healthcare services will be covered without copay, says Gaydos, so you don’t have to worry about getting hit with surprise fees as you’re walking in to your doctor’s appointment. What do preventative services look like? Pap smears, screenings and mammograms for women.
The ACA doesn’t cover your healthcare provider selection, so finding a good OB when you’re expecting is still up to you. “Depending on your insurance place,” says Gaydos, “you can choose from a list of preferred providers, but that remains specific to the insurance plan you have and not the Affordable Care Act.” The same goes for prenatal appointments. Gaydos notes that the ACA should not have any effect on what happens at your prenatal appointments, including the timing or how they’re scheduled. But there’s an upside! No more copays. “Under the Act, all prenatal care services must be provided with no copay,” she says. (That means more money for baby gear!)
No more gender bias
According to ObamacareFacts.com, under the Affordable Care Act, women will no longer be denied insurance coverage for gender-related reasons. That means that “pre-existing conditions” like a c-section in an earlier birth won’t hold you back from getting the quality care you deserve. Obamacare outlaws the gender-bias practice.
Another reason to celebrate? Women won’t pay more for insurance just because they’re women. The practice known as “gender rating” (where insurers can charge a woman more for the same health benefits a man receives) will be totally dismembered and made illegal (praise be!). So the recorded $1 billion more that women pay for health insurance? You can (proudly) kiss it goodbye!
Another benefit for moms-to-be? Under Obamacare, folic acid supplements will be available to women — as well as breast pumps. Gaydos says that the Affordable Care Act requires insurances to cover breast pumps. "It's an amazing thing,” says Yummy Mummy owner Cole. “I think it’s really going to help moms reach their breastfeeding goals.”
But don’t click "buy" just yet. While the coverage is cool, the specifics are still a little murky. “Most private insurance companies have created their own policies about what types and brands of breast pumps they will cover, but there’s no national standard, which is a little unclear,” Gaydos explains. “Women should contact their insurance providers before purchasing a breast bump to get a copy of their policy and the details.”
And in some cases, instead of giving you a breast pump, providers are creating policies to determine how much money they'll give moms-to-be toward their pumps from a durable medical equipment supplier (known as a DME). A DME is contracted through your provider, so you'll need to ask ahead of time which DME you'll work through and how much will go toward your breast pump purchase.The upside is that you have more control over the pump you're provided with (in most cases you'll be able to speak directly with the DME to get the pump you want), but the downside is that you'll have to be your own best advocate to make sure you're getting exactly what your coverage provides.
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