Does Maternity Insurance Matter? What Expecting Parents Should Know in 2025

Most U.S. marketplace and employer plans cover maternity as an essential benefit; Medicaid also covers pregnancy for eligible people. Short-term and some non-ACA plans can exclude maternity. Review network providers, coverage for delivery and NICU, postpartum services, and newborn enrollment rules. A separate maternity rider may be useful only when primary coverage is lacking.

Do you need maternity insurance?

Pregnancy brings medical, emotional and financial changes. In many countries, public programs or employer plans already cover prenatal care and delivery. Still, reviewing your health insurance before or early in pregnancy matters: it determines what care is in-network, what you'll pay out of pocket, and how newborn care is handled.

What standard health plans cover

In the United States, maternity and newborn care are one of the "essential health benefits" required for ACA-compliant individual and small-group marketplace plans. Employer-sponsored group plans commonly cover pregnancy as well, though specifics vary. Medicaid also covers pregnancy-related care for eligible individuals; eligibility and benefit details vary by state.

That means most people with marketplace, employer, or Medicaid coverage will have at least basic prenatal visits, deliveries, and immediate newborn care covered. However, coverage limits, deductibles, and network rules affect your final bill.

What can still be excluded or limited

Some short-term or non-ACA plans exclude maternity care. International or private supplemental products may offer maternity riders or packages - useful where public coverage is limited but unnecessary where comprehensive plans already include maternity.

Even with coverage, expect out-of-pocket costs: copays, coinsurance, and deductibles can apply. High-cost care - like a prolonged neonatal intensive care unit (NICU) stay, major complications, or repeat cesarean sections - can drive bills higher and highlight the value of strong in-network coverage and a low out-of-pocket maximum.

Practical items to check now

• Confirm whether your plan is ACA-compliant or a short-term/non-ACA product.

• Verify in-network maternity providers (obstetrician, hospital, midwife, birthing center).

• Ask about coverage for prenatal tests, ultrasounds, C-sections, and NICU care.

• Check postpartum coverage: follow-up visits, contraception counseling, and mental-health services for postpartum depression.

• Learn rules for adding a newborn to your plan (many insurers and HIPAA rules allow a special enrollment window - commonly 30 days).

• Explore state paid family leave or employer short-term disability for income replacement during leave.

When a separate maternity policy makes sense

A standalone maternity rider or private plan may make sense where public or employer coverage is absent, limited, or has long waiting periods. In countries with universal coverage, separate maternity insurance is usually unnecessary.

Bottom line: maternity insurance isn't universally "required," but verifying maternity and newborn benefits, network access, and potential out-of-pocket costs will protect you from unexpected bills and help you plan prenatal and postpartum care.