Having a Baby? How ACA Coverage and Special Enrollment Work for New Parents

3 min read

A new baby brings joy, and a long list of decisions. Health coverage should be near the top. If you are expecting, adopting, or just had a baby, a Special Enrollment Period (SEP) may let you enroll or change plans outside Open Enrollment. This guide explains how it works for new and expecting parents.

Having a Baby Can Open a Special Enrollment Period

Birth and adoption are among the common qualifying life events. If you have a baby, adopt a child, or have a child placed with you for adoption or foster care, you may be able to enroll in a Marketplace plan or switch plans. For most events of this kind, you generally have 60 days from the date of the event to choose a plan.

When Can Coverage Start?

For a birth or adoption, coverage may be able to start as early as the first day of the month in which the baby was born or the adoption occurred, as long as you pick a plan and pay your first premium within the allowed time. That helps cover costs from the early days. Your plan's start date is shown when you select it, so check the date and pay the premium on time.

Maternity and Newborn Care Are Essential Health Benefits

All Marketplace plans must cover maternity and newborn care as an essential health benefit. That includes prenatal visits, labor and delivery, and care for the baby. What you pay still depends on the plan's deductible, copays, and coinsurance, so look at those costs and not just whether maternity is covered.

If You Are Expecting but Have Not Delivered Yet

Pregnancy by itself is not usually a qualifying life event for a Special Enrollment Period. If you are pregnant and need coverage, Open Enrollment is the main opportunity unless another event applies. Check with HealthCare.gov or your state Marketplace for your situation. If you already have a plan, review it before your due date:

  • Is your obstetrician or birth hospital in the network?
  • What are the deductible and out-of-pocket maximum?
  • Is your baby's pediatrician in the network?

Adding Your Baby to Your Plan

Newborns are not covered automatically on every plan. Enroll your baby within the SEP window so the baby is covered from the start date. If you already have a family plan, you generally add the baby by reporting the birth to the Marketplace and the insurer.

Medicaid and CHIP May Apply

Depending on household income and state rules, your child, or you during pregnancy, may qualify for Medicaid or CHIP. Applying through the Marketplace screens for both. If you are uncertain, our guide on family coverage explains how the application treats children.

How It Fits With Open Enrollment

If your baby is born near the end of the year, you may have more than one way to enroll. Compare the deadlines in our Open Enrollment guide with your SEP window so you do not miss either.

A Checklist for New and Expecting Parents

  1. Note the date of birth or adoption. The 60-day window runs from that date.
  2. Compare plans for the whole family, including the baby's pediatrician.
  3. Report the birth to the Marketplace and your insurer.
  4. Pay your first premium on time so coverage starts when expected.
  5. Save the birth certificate or adoption paperwork, which the Marketplace may ask for.

Sources and Further Reading

Frequently Asked Questions

How long do I have to enroll after my baby is born?

For most events of this kind, 60 days from the date of birth or adoption.

Is maternity care covered on every Marketplace plan?

Yes, maternity and newborn care are essential health benefits. What you pay depends on the plan.

Does pregnancy open a Special Enrollment Period?

Not by itself. Other events may qualify, so check the current rules.

Do I need to add my baby to my plan?

Yes, report the birth so the baby is enrolled.