Newborn Health Insurance

Posted: September 25, 2024

There is so much to prepare when you’re expecting a baby — especially when it’s the first time. In the midst of setting up the nursery, making extra trips to the doctor for prenatal appointments, and securely fastening your brand-new baby car seat, there is always one question looming in every new parent’s mind — “is my newborn covered under my insurance?”

Whether you, as a parent, have health insurance but don’t know much about it or don’t have health insurance at all, navigating the process of getting your newborn health insurance coverage can be tough. Unfortunately, health insurance for newborns isn’t something that just happens on its own.
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While there is a short buffer period built in to give newborn coverage through his/her mother’s insurance, the longer you wait to get newborn insurance coverage in California, the more you will have to pay. While the Affordable Care Act and California State Laws make it mandatory for health insurance companies to accept newborns to health insurance plans, there’s no guarantee on pricing. If you fail to do your part to get your newborn on a health insurance plan, you could end up spending a significant amount of money.

How Health Insurance Works for Newborn Babies

Health insurance policies for newborns work the same way as your health insurance plans. Depending on the plan, all or some of your baby’s health care will be covered by your provider. This also means that there will be deductibles, co-payments and out-of-pocket expenses.

It is vital to know that the health insurance coverage you have during pregnancy does not automatically cover your newborn, especially beyond the first 30 days after birth. Following this, you will need to add your baby to your work-based plan, private coverage or Affordable Care Act (ACA) plan.

The Benefits of Newborn Health Insurance

Having health insurance coverage for your newborn ensures access to services that are vital for your baby’s health and well-being and your peace of mind. The benefits your baby will receive will vary depending on the health insurance plan you choose but typically include:

Well-baby visits: Most plans cover well-baby checkups. During the visits, a health professional monitors your baby’s growth and includes developmental screenings and physical examinations as part of the checkup.
Prescription medication: Insurance plans generally cover prescription medication for your baby, but the type of medication and the extent of the coverage will vary by plan.
Vaccinations: Vaccinations are an essential part of a newborn’s wellness journey. They help protect your child from various infectious diseases, such as measles and whooping cough. Most health insurance programs cover your baby’s routine vaccinations.
Specialist care: Many health insurance plans for newborns cover specialist care, like pediatric cardiologist appointments. However, most plans require a referral letter from your primary care physician before covering specialist visits.
Emergency care: A visit to the emergency room is never expected and can be especially stressful. Having health insurance for your newborn ensures that, diagnostic tests and treatments are covered in the event of an emergency.
Hospitalization: There may be times when hospitalization is necessary for your infant to receive the best care. Newborn health insurance can cover routine hospitalization, like after-birth care, and more specialized stays, including neonatal intensive care unit (NICU).

The Risk of Not Having Newborn Insurance Coverage in California

The reality is that newborn care can be a heavy expense. The key to minimizing cost and making sure your new baby is covered is planning. If you haven’t decided what to do about getting insurance for your newborn in California before your little one arrives, you can easily forget all about insurance coverage while you enjoy being a new parent.

Unfortunately, coverage isn’t instant, and it is never worth the risk to your newborn or your family’s well-being by having the added burden of out-of-pocket expenses.

How Long Is a Newborn Covered Under Mom’s Insurance?

For the first 30 days, a newborn is covered under the mother’s insurance as an extension of her policy and deductible. After this 30-day period, your baby must have his or her policy. You could simply add your baby to your employer-provided insurance or convert from your individual policy to a family plan.

Remember, all this takes planning, paperwork and time, and it has its own associated costs. Preparing ahead of your baby’s birth is key.

Parents Don’t Have Health Insurance

If the mother and father of a newborn do not have health insurance, then all expenses must be paid out of pocket. Recent data shows that it costs $18,865 on average to give birth. That’s a huge financial burden for new parents to take on. If that isn’t enough of a reason for you to get health insurance before your newborn arrives, the possibility of putting the baby’s health at risk should be.

Although a mom’s insurance plan covers a newborn for the first 30 days, not every mother has health insurance. In this case, babies whose mothers do not have health insurance are not covered. This would mean that the baby would either miss essential doctor’s visits or that the parents would be paying a significant amount out-of-pocket.

Types of Health Insurance Coverage for Newborns

There are several options available to parents looking for the right coverage for their newborn:

Employer-Sponsored Coverage and Private Health Insurance

You can enroll your child on your individual plan and tailor it according to different levels of coverage (though this will increase your premium.) Family plans can be a more economical option, as they are designed to cover your whole family — including your baby — all under one policy.

It is up to your family to decide which plan works best for your baby. Family plans usually have higher premiums, but depending on your family, they can be more cost-effective than having separate individual plans for each family member.

Public Health Insurance Programs

Two of the main government initiatives that provide affordable coverage include Medicaid and the Children’s Health Insurance Program (CHIP). For Medicaid, you can apply and enroll for coverage at any time of year, depending on whether you qualify. The eligibility guidelines for CHIP vary from state to state, but if you are successful in receiving CHIP benefits, rest assured that it provides coverage for check-ups, immunizations, doctor’s visits and prescriptions, emergency care and more.

Options Provided by Health for California

While everyone welcoming a new baby into their life will see an increase in health insurance costs, being proactive can ensure that those costs are manageable. The reason it’s important to plan to get insurance for newborns in California is that you need time to gather quotes and review benefits. Health for California is a great place to start, and it can save you a lot of time.

Health for California is a health insurance agency that has developed a free, no obligation, one-stop-shop website for health insurance quotes — regardless of whether you’re searching for a new family plan or a child-only health insurance plan. It is certified to give quotes from Covered California as well as quotes from private insurance companies. The simple online form asks you a few basic questions and provides a list of health insurance plan results that you can compare side by side.

Health for California can give you quotes on the following:

Child-Only Health Insurance Quotes California

If you and your partner don’t have insurance and don’t plan on getting insurance, a child-only health insurance plan makes the most sense. However, parents who have insurance may also want to consider a child-only policy for the following reasons:

It’s more expensive to add your newborn to your pre-existing plan.
You’re paying for health insurance for your newborn, but they won’t be living with you.
You’re paying for health insurance for your newborn, but they’re not a part of your tax household.

Covered California Quotes for Individuals and Families

The Covered California Health Exchange is a government agency that helps Californians comply with Obamacare. To comply with Obamacare, you need to have insurance coverage from a qualified health plan that meets the government’s requirements. While you usually can only enroll during the open enrollment period, the birth of a child gives you the ability to apply for Covered California health insurance outside of the open enrollment period.

Parents with a baby on the way may look for a new health insurance policy for the following:

The cost of adding your newborn to your pre-existing plan is high.
You and your partner do not currently have insurance.
You and your partner would like to get on an insurance plan together when the child is born.

Fill out a simple online form with some basic information, including your income, and you’ll see various plans in the results. The details you will be able to compare include:

Carrier name
Plan category
Plan type
Full prices for each plan
The price you pay
The subsidy amount you may qualify for
And a link to the benefits

Your income level may qualify you for discounted rates — all of which you can find on the Health for America website. There are additional parameters for pregnant women with low incomes, too. As a female who is expecting, you could qualify for Medi-Cal. Entering your household income information in the optional section of the forms will ensure all of the plans you are eligible for will appear in the results.

How to Get Your Baby Health Insurance Coverage in California

In California, you can add your baby to either parent’s insurance plan, regardless of marital status. The steps you take to add your child to your medical will depend on your existing policy — if you have it through an employer, if you have your own individual or family plan or if you don’t currently have insurance.

The Parent Has Health Insurance Through an Employer

If you have a group health insurance policy through your employer, start by talking to your human resources office. Here are a few questions you should ask:

How much will it cost to add my newborn to my group plan?
What are the benefits included in that price? Are there any specific to newborns?
What paperwork do I need to fill out to add my newborn to my group plan?
What is the deadline for submitting the paperwork?
When will the coverage start?

The mother and father of the baby should compare notes on how much it will cost to add the child to the group plan and should also review the benefits of each plan to determine the best value. If one parent has health insurance through an employer, and the other parent has an individual health insurance plan, review the cost and the benefits to see which policy is best for your newborn.

The Parent Has an Individual or Family Health Insurance Plan

If you have an individual or family health insurance plan, call your insurance company directly and talk to them about what options they offer for adding a newborn to your plan. You should ask them questions such as:

How much will it cost to add my newborn to my individual or family plan?
What process do I need to follow to get my newborn added to my plan?
When will coverage begin for my newborn?
Will the coverage for my newborn be the same as my coverage?

If this is not your first child, you may be pleasantly surprised to find that the increase you had with the first baby will not occur with your second or third. It’s also important to note that when you add another child to the family, it’s often worth revisiting health insurance plans for the entire family. For example, you may have your child on a separate plan, but now that you have two children, there may be a better family plan rate available.

If parents are not on the same individual or family health plan, it’s important to compare coverage to see whether the mother or father’s health insurance policy offers better value for the newborn. This may also be an opportunity to get more value from your health insurance policy by searching for a family health insurance policy that covers both parents and the new child.

Neither Parent Has Health Insurance

If insurance is available through the mother or father’s employer, talk to the human resources office about what coverage is available. Remember that in California, a newborn can be added to a mother or father’s policy within the first 30 days. The parents of the child do not need to be married.

If insurance is not available through an employer, begin shopping for an insurance policy. Whether you’re searching for an individual plan that you can eventually add your child to or a child-only insurance plan that will cover your child, search online through the Health for California to learn what coverage is available and how much it will cost. You can also learn more about the different categories of plans as you browse our website to see what plan offers the best value for you and your newborn.

Don’t Get Stuck Without Newborn Insurance Coverage in California

Neglecting to plan to get health insurance for your newborn will result in significant financial burdens. If a mother has a child without insurance in California, she could owe up to $45,000 for the delivery of her child alone. Even if both parents have insurance, failing to get a plan in place for their newborn to have coverage on day 31, after the 30 days of coverage as an extension of the mother, can result in paying an additional 20% more the entire first year as a penalty for not having coverage.

At Health for California, our goal is to make it easy for Californians to get the health insurance coverage they need for themselves and their newborn. Our website is focused on educating those who may not know much about health insurance and making it easy to find an affordable health insurance solution for mothers, fathers and children. Begin your new adventure as parents by requesting a free, no-obligation quote on our website so you can be sure your newborn has the best health insurance plan from the moment they arrive.

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