What to Check Before Your Baby Arrives: A Maternity Insurance Checklist

Start with your current insurance documents

Before you do anything else, pull out your insurance card and the documents that came with your plan — usually a summary of benefits or a member handbook. You need to know three things right now: whether maternity is covered at all, what your out-of-pocket costs will be (deductible, copay, coinsurance), and whether you need pre-authorization before labor.

If you cannot find these documents, call the customer service number on your insurance card. Tell them you are pregnant and ask them to mail or email you a summary of your maternity benefits. Write down the date you called and the name of the person who helped you. You will need this record if something goes wrong later.

If you do not have insurance right now, you may still have options during pregnancy. Some states let you enroll in Medicaid outside the normal enrollment period if you are pregnant, and some marketplace plans have special enrollment periods for life changes. Check your state's Medicaid office or Healthcare.gov to see what is available in your area.

Key Takeaways

• Your insurance documents tell you whether maternity is covered, what you will pay out of pocket, and whether you need permission before going to the hospital.
• Pre-authorization means calling your insurance company before labor to notify them — some plans require this, and skipping it can cost you thousands.
• In-network hospitals and doctors cost less than out-of-network ones, so confirm your hospital is in your plan before you deliver.
• Newborn coverage is automatic for 30 days after birth on most plans, but you must add your baby to your insurance within that window or lose coverage.
• Unexpected costs like neonatal intensive care or a longer hospital stay are common and can exceed your deductible, so understand your maximum out-of-pocket limit.

Confirm your hospital and doctor are in your insurance network

Call your insurance company and ask whether your hospital and your doctor or midwife are in-network. If they are not, you will pay significantly more — sometimes double or triple the in-network cost. If your preferred hospital or doctor is out-of-network, you have time to switch before labor, or you can decide whether the cost difference is worth it to you.

Write down the in-network status of each provider and keep this information with your insurance card. Bring it to every appointment. If you change hospitals or doctors, call your insurance company again to confirm the new provider is in-network.

Find out what pre-authorization means for your plan

Some insurance plans require you to call and notify them before you go into labor. This is called pre-authorization or pre-notification. It does not mean asking permission — it means telling your insurance company that labor has started so they can flag your claim and process it correctly. If your plan requires this and you do not do it, your claim may be delayed or denied, and you could receive a bill weeks or months later.

Call your insurance company now and ask: "Do I need to call you before I go to the hospital to deliver?" Write down the answer and the phone number to call. Ask whether there is a specific department or line for maternity pre-authorization. Put this phone number in your phone and give a copy to your partner or whoever will be with you during labor.

Understand your out-of-pocket costs

Your insurance documents should list three numbers: your deductible (the amount you pay before insurance starts paying), your copay or coinsurance (your share of each bill), and your maximum out-of-pocket limit (the most you will pay in a year). Maternity and delivery can involve multiple bills — the hospital, the doctor, lab work, ultrasounds, anesthesia — so your actual cost may be higher than you expect.

Ask your insurance company for an estimate of what you will pay for a vaginal delivery and a cesarean delivery. These are two different procedures with different costs. Write down both numbers. Ask whether the estimate includes the hospital stay, the doctor's fee, and anesthesia, or whether those are billed separately. Ask whether your deductible has already been met this year, because if it has not, you will pay the full deductible before insurance starts paying.

If the out-of-pocket cost is more than you can afford, ask your hospital's financial aid office whether you may have access to for a payment plan or financial assistance. Many hospitals offer these programs and do not advertise them widely.

Add your newborn to your insurance within 30 days

Your newborn is automatically covered by your insurance for 30 days after birth. After that, you must add them to your plan or they lose coverage. Do not wait until the last day — call your insurance company within the first week after birth and ask how to add your baby. You will need your baby's name, date of birth, and Social Security number.

If you are on Medicaid, the process is different. In most states, your baby is automatically enrolled in Medicaid at birth if you are enrolled. Call your state Medicaid office to confirm your baby was added and to find out what you need to do next.

If you are uninsured or on a marketplace plan, you have 60 days after birth to add your baby without waiting for open enrollment. This is called a special enrollment period. Contact your insurance company or Healthcare.gov to start the process.

Plan for unexpected costs and longer stays

Most vaginal deliveries result in a one- or two-night hospital stay. Cesarean deliveries usually mean three nights. But complications — infection, bleeding, high blood pressure, or problems with the baby — can extend your stay or require neonatal intensive care. These situations are not rare, and they can add thousands of dollars to your bill.

Ask your insurance company what your maximum out-of-pocket limit is for the year. This is the most you will pay no matter how long you stay or how many complications arise. Once you hit this number, insurance pays 100 percent of the rest. Knowing this number helps you plan financially and understand your worst-case scenario.

If you are having a planned cesarean or if your doctor has told you to expect complications, call your insurance company in advance and ask for an estimate that includes a longer hospital stay. Be specific: "What if I stay five nights instead of three?" This gives you a more realistic picture of what you might owe.

Keep records of every call and bill

Create a folder — physical or digital — and put everything in it: your insurance card, your member handbook, notes from every call to your insurance company (date, time, person's name, what they said), your hospital pre-registration paperwork, and every bill you receive after delivery. Insurance companies sometimes lose records or deny claims by mistake, and your notes are proof of what you were told.

If you receive a bill you do not understand, call your insurance company first and ask them to explain it. If they say it should have been covered, ask them to contact the hospital on your behalf. If you still disagree with the bill, you have the right to appeal. Keep all your records until you are certain the bill is resolved.

Frequently Asked Questions

What if I do not have insurance when I find out I am pregnant?

Many states allow you to enroll in Medicaid during pregnancy even if it is not open enrollment. Go to your state Medicaid office website or call 211 to find out whether you may have access to and how to enroll. If you do not may have access to for Medicaid, you may be able to enroll in a marketplace plan through Healthcare.gov during a special enrollment period for pregnancy.

Do I have to use an in-network hospital?

You do not have to, but using an out-of-network hospital will cost you significantly more. If your preferred hospital is out-of-network, ask your insurance company for an estimate of the difference. Then decide whether the extra cost is worth it to you. Some people choose to pay more for a specific hospital or doctor they trust.

What happens if I go into labor and forget to call for pre-authorization?

Call your insurance company as soon as you can — ideally before you leave the hospital, but certainly within a few days. Explain that you were in labor and did not have time to call ahead. Most insurance companies will still process your claim correctly if you notify them shortly after delivery. Having your pre-authorization phone number written down and given to your partner helps prevent this problem.

Can I change insurance plans while I am pregnant?

You cannot change plans during open enrollment if you are already covered, but you can switch if you lose your current coverage or if you may have access to for a special enrollment period. Pregnancy itself is a may have access to life event in some states. Call your current insurance company and ask whether you can switch, or contact Healthcare.gov to see what options are available in your state.

What if my insurance denies a maternity bill after I deliver?

Call your insurance company and ask why the claim was denied. Write down the reason. If you disagree with the denial, you have the right to appeal. Ask your insurance company for the appeal process and the deadline. You can also ask your hospital's billing department to appeal on your behalf — many hospitals do this routinely.