Introduction
If you’ve recently had a baby or adopted a child, congratulations! Adding a new family member is an exciting life event. It also presents the opportunity to review your health insurance options outside of the normal Open Enrollment Period.
The Open Enrollment Period for signing up for health insurance on the Affordable Care Act (ACA) marketplace is generally November 1 to December 15 each year. But when certain life events occur, like having a baby, you qualify for a Special Enrollment Period where you can sign up for or change your health insurance plan outside of Open Enrollment.
Signing up during this Special Enrollment Period allows you to get health coverage for your new baby as well as adjust your plan to meet the needs of your growing family. Don’t worry about navigating this process alone – this guide will walk through the steps to enroll in health insurance after having a baby and ensure your family has the coverage you need.
Who Qualifies
The birth or adoption of a child allows parents, adoptive parents, and legal guardians to enroll in health insurance through a Special Enrollment Period (SEP) on the Health Insurance Marketplace.
You may qualify for this SEP if:
- You are the birth parent of a newborn child, even if you were not previously enrolled in a health plan
- You have adopted a child or been matched with a child for adoption
- You have become the legal guardian of a child
Both parents and legal guardians have 60 days from the child’s birth, adoption, or placement to enroll in coverage. This gives you time to evaluate your new insurance options and enroll your child in health coverage.
To qualify for this SEP, you must show documentation proving your relationship to the child, such as a birth certificate or adoption paperwork.
When to Enroll
You can enroll in health insurance through a Special Enrollment Period when you have a qualifying life event, like having a baby. Here’s when you need to enroll:
- 60 days before your due date: You can apply for health insurance up to 60 days before your due date. This gives you coverage during pregnancy, labor and delivery.
- During your pregnancy: You can enroll at any time during your pregnancy. Coverage will start the first day of the following month. This ensures you have health insurance when the baby arrives.
- Up to 60 days after delivery: You have 60 days after giving birth to enroll yourself and your newborn in a health plan. This window gives you time to take care of your new baby before having to deal with paperwork.
Coverage will be retroactive to the date of birth if you apply within 60 days. So don’t worry about submitting the application right away. Focus on caring for your new baby first.
How to Enroll
To enroll in health insurance through healthcare.gov after having a baby, follow these steps:
- Go to obamacarequotes.com and click on “Apply Today.”
- You will need to create an account if you do not already have one. Provide your personal information to create an account.
- Once your account is created, you can shop for health insurance plans you are eligible for in your area. Make sure to indicate that you recently had a child.
- Be prepared to provide documentation as proof of birth if requested. This could include the baby’s birth certificate or hospital discharge paperwork.
- After selecting a health insurance plan that fits your needs and budget, enroll online and make your first premium payment. Print or save confirmation of your enrollment.
- Coverage will typically start on the baby’s birth date if you enroll within 30 days. If you enroll after 30 days, coverage may start later.
Enrolling online or by phone are the two main ways eligible parents can sign up for health insurance after having a baby. Just be sure to act within the special enrollment period to avoid delays in coverage.
Coverage Start Date
If you enroll in a health insurance plan right away after your baby is born, coverage will start retroactively on your baby’s date of birth. This ensures your newborn is covered for any health expenses or complications from the birth.
However, if you don’t enroll right away, coverage will start on the first day of the month after you select a health plan. For example, if your baby is born on May 5th but you don’t enroll until June 10th, coverage would begin July 1st. Any medical costs your baby incurs between their birth on May 5th and the coverage start date of July 1st would not be covered.
The key is to enroll as close to your baby’s birth date as possible. This guarantees there are no gaps in health insurance coverage and provides you and your newborn peace of mind. Contact the health insurance marketplace immediately after your baby arrives to begin the special enrollment process.
Plan Options
When enrolling in a health insurance plan through the Affordable Care Act marketplace, you have several coverage options to choose from. Marketplace insurance plans fit into four main categories – Bronze, Silver, Gold and Platinum. Here’s an overview of what each plan level covers:
Bronze
Bronze plans have the lowest monthly premiums, but the highest costs when you need care. Bronze plans cover about 60% of average healthcare costs. This means you’ll pay 40% of costs in the form of deductibles, copays, and coinsurance. Bronze plans make the most sense for healthy people who don’t expect to need much medical care.
Silver
Silver plans offer a balance between premiums and healthcare costs. They cover about 70% of average costs, while you’re responsible for the remaining 30% out-of-pocket. Silver plans are a good choice if you expect to use some healthcare services. Most people find Silver plans to be the best value.
Gold
Gold plans have higher premiums but lower healthcare costs than Bronze and Silver plans. They cover about 80% of average costs. This leaves you responsible for 20% out-of-pocket through deductibles, copays and coinsurance. Gold plans are a good choice if you expect to need frequent medical care.
Platinum
Platinum plans have the highest premiums but the lowest healthcare costs. Platinum plans cover about 90% of average healthcare expenses. You would only pay 10% out-of-pocket for care. Platinum plans make sense for those who expect to need a lot of care due to chronic illnesses or health conditions.
Every marketplace plan, no matter the level, covers essential health benefits like preventive care, maternity care and prescription drugs. Choosing the right metal tier involves balancing your monthly premium costs with your expected healthcare needs for the year.
Financial Assistance
Having a baby can be expensive, so it’s important to understand what financial assistance is available through the Affordable Care Act (ACA) marketplace plans. Two main types of financial assistance can lower your health insurance costs:
Subsidies and Tax Credits
- Premium Tax Credits: These tax credits help lower your monthly insurance premiums. The credit amount depends on your income level and family size.
- Cost-Sharing Reductions: If your income is up to 250% of the federal poverty level, you may qualify for extra savings that lower your out-of-pocket costs like deductibles and copays.
To find out if you qualify for subsidies or tax credits, you’ll need to complete an application on the ACA marketplace website. Based on the information you provide about income and family size, it will calculate the amount of financial assistance available to you.
The tax credits can be applied right away to lower your monthly premium bill. Or you can choose to claim the full credit when you file taxes for the year. Cost-sharing reductions are also applied automatically once enrolled in a Silver-tier marketplace plan.
Medicaid
In addition to marketplace plan subsidies, Medicaid provides free or low-cost coverage options for those with limited income. Having a baby may qualify you for Medicaid depending on your state’s eligibility rules. It’s worth exploring this option as well when seeking ACA enrollment.
Maximizing subsidies and financial assistance is key to finding an affordable health plan that will cover you and your new baby. The ACA marketplace makes these savings available, so be sure to enroll and shop the plans to see what options fit your budget.
Adding Baby to Plan
Once your baby is born, you will need to add them to your health insurance plan. It is important to add your newborn within 30 days of their birth. Here are some key things to know:
- You must contact the health insurance marketplace and formally add your baby to your health plan within 30 days of your child’s birth. If you miss this window, you will have to wait until the next open enrollment period to sign them up.
- Like your own special enrollment period, your baby being born triggers a 30 day special enrollment period where you can add them to your existing plan or choose a new plan entirely.
- Your baby’s coverage will be effective retroactively to their date of birth, as long as you add them within the 30 day timeframe. So they will not have any lapse in coverage.
- Once added, your baby will be covered under your plan’s benefits just like any dependent. Make sure to understand things like the deductible, co-pays, providers in network, etc.
- If you have a marketplace plan with financial assistance, notify the marketplace when adding your baby. Your subsidies will be updated to include your new family member.
- You can add your baby online through the federal marketplace healthcare.gov or your state marketplace website if applicable. Call the marketplace helpline if you need assistance adding your newborn.
Act quickly to formally enroll your newborn within 30 days of their arrival to ensure they have comprehensive health coverage right from birth. Take advantage of this special enrollment period designed specifically for new parents.
Alternate Options
Having a baby allows for special enrollment in an Obamacare health insurance plan. However, there are some alternate options to consider as well:
- Staying on a parent’s plan: Children can remain on their parent’s health insurance plan until they turn 26 years old, regardless of marriage, financial dependency, enrollment in school, or residency with parents. This option may be worth exploring if the parents’ plan offers sufficient coverage for both the parent and new baby. The baby can be added to the parent’s plan even if the adult child is not covered.
- CHIP: The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage for children in families that earn too much to qualify for Medicaid but cannot afford private insurance. CHIP eligibility varies by state but generally covers uninsured children up to age 19 in families with incomes up to 200% of the federal poverty level. Each state has its own program and enrollment rules. This could be an option to cover the new baby if other coverage is unaffordable.
Both staying on a parent’s plan and CHIP are alternatives worth looking into when evaluating health insurance options after having a baby. They can provide coverage for the child and potentially the entire family.
Next Steps
The most important next step is to enroll in a health insurance plan through the Marketplace as soon as possible after the baby’s birth to ensure full health coverage. The Special Enrollment Period is only open for 60 days after a qualifying life event like having a baby, so it’s essential to act quickly.
Consult a patient navigator or broker who can walk through plan options and provide personalized guidance on choosing the best coverage. Navigators are trained experts who offer free assistance with Marketplace enrollment. They can answer any questions about plans, financial assistance, adding the baby to your coverage, and making sure you complete all steps to gain coverage. Having an expert advisor can streamline the process and ensure you make the best choices.
Don’t delay – gain peace of mind knowing your family will have comprehensive health coverage by starting the enrollment process right away. Take advantage of this limited-time opportunity to get insured following the wonderful and life-changing event of having a new baby.