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Answers to Questions You May Have About Maternal & Prenatal Care Benefits in Open Enrollment Season

At Stand Up for APA, our priority is to ensure that all pregnant women in the U.S. have access to the best prenatal and maternal care. This includes access for all to the safest, highest quality prenatal genetic screening options. While prenatal care continues to advance, the results are already clear: non-invasive prenatal testing (NIPT) remains the single most accurate screening test for chromosomal disorders.


And with open enrollment season for the Health Insurance Marketplace upon us, now is the perfect time for all women to check whether the maternal and prenatal benefits offered by their health insurance plans – private or public – cover their health care needs.


Here are some answers to important questions you may be asking about your maternal and prenatal care benefits:


What should I know about how my plan covers costs related to pregnancy and giving birth?


Most maternity costs are detailed in a plan’s Summary of Benefits and Coverage document. Be sure to review plan details such as copays, coinsurance rates deductibles, and out-of-pocket maximums to avoid surprise charges during prenatal and maternal services such as labor and delivery, midwife services, medically prescribed C-sections, or neonatal care.


Are my preferred doctors and medical facilities in-network?


Check to see if preferred physicians and medical facilities are covered and in-network. Plan details can vary widely if a mother anticipates using infertility treatments, a nurse-midwife, or an independent birth center.


What specific services and procedures does my plan include for prenatal and maternity care?


Beyond reviewing the costs, make sure to carefully review a health plan’s summary of benefits to see the specific set of prenatal and maternal care services it covers. Most plans cover “essential services” such as delivery and inpatient hospital services, but other services, such as prenatal services, health screenings, lab work, ultrasounds, and birthing classes may not be covered.


For reference, approximately 80% of insured patients in the US are covered for NIPT regardless of risk – which we here at Stand Up for APA are focused on – and nearly 100% are covered in a high-risk pregnancy. Work is still needed to guarantee that 100% coverage, regardless of a woman’s risk, socioeconomic status, or insurance option, exists without administrative burdens or delays such as prior authorization requirements. The only national insurance company that still requires prior authorization for access to NIPT is UnitedHealthcare, while companies like Anthem and Cigna have broken down those barriers. On a related note, AIM Laboratory Management has also held onto these burdensome prior authorization requirements for NIPT access.


Prior authorization requires physicians to request authorization before conducting specific tests, procedures, or care such as NIPT. This places an unnecessary burden on both expecting mothers and healthcare providers, as stated by the American College for Obstetricians and Gynecologists (ACOG). The statistics tell the story – a 2020 American Medical Association physician survey found that 94% of expert respondents agreed that preauthorization requirements delay their patients’ access to necessary care, and 79% agreed this can sometimes even lead to their patients abandoning treatment altogether.


What can be done to ensure better coverage and more access to top-notch maternal and prenatal care options like NIPT?


Silence is the enemy in the battle for equitable access to the best maternal and prenatal care options for all. We must continue to educate ourselves on these issues, share information, and ask all insurers to follow the recommendations of top organizations like ACOG, SMFM, and ACMG, such as their recommendation of NIPT for all pregnant women, without any barriers to access – including prior authorization requirements.


All women—regardless of race, ethnicity, geography, or socioeconomic background—deserve access to the best prenatal and maternal care options. Together, we can work to remove any barriers standing in the way of that.


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