If you’re seeking health insurance for a newborn, prepare to take the following steps:
- Explore your options for insuring baby
- Consider the costs of health insurance for newborns
- Make your insurance selection
- Get documentation ready
- Apply and enroll baby into a health insurance policy
- Receive confirmation of coverage
Having a baby is exciting, but it comes with some less exciting to-do items—like sorting out baby’s health plan. However, getting insurance for your new child doesn’t need to be complicated. Read on to learn about health insurance for newborns.
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The Importance of Enrolling Your Newborn on Your Health Insurance Policy
Your child’s health is of the utmost importance. A new baby typically needs a series of vaccines and tests, and you can expect frequent doctor’s visits during your child’s first year of life, all of which can get costly without sufficient health care coverage.
Health insurance for newborns functions the same as health insurance for adults. Baby’s policy helps cover the cost of postnatal care, physician’s appointments, immunizations, prescription medications, lab services, emergency services, and inpatient or outpatient care.
Maternity care and newborn care are considered essential health benefits, meaning all qualified health insurance plans certified by the Health Insurance Marketplace are required to cover them.
1. Explore Your Options for Insuring Baby
When it’s time to choose a health plan for your newborn, you can explore options through your employer-sponsored plan, the Health Insurance Marketplace, or public health insurance programs. You might even pursue child-only health insurance if you need to buy a policy for just your baby.
Employer-Sponsored Plan
With employer-sponsored health insurance, your employer offers a selection of health insurance plans to you and your dependents, subsidizing the premium for whichever plan you choose.
Most employer-sponsored plans only allow you to enroll during a certain window of time each year, but these plans make exceptions for certain qualifying life events—such as having a baby—which prompt a special enrollment period.
After your child is born, your plan should automatically cover baby for the first 30 days of life. During this time, your newborn is covered under your policy, as an extension of you. However, this automatic coverage ends once those 30 days are up, so it’s important to add your child to your insurance policy prior to that. Once you enroll your newborn, coverage for baby retroactively extends to the day of birth.
One parent/guardian’s policy
If the parents are unmarried, the newborn can only be enrolled in one parent’s policy. The father may only add a baby to his policy once paternity has been established, regulations for which vary by state and health insurance plan. If the parents are married but only one is insured, the newborn can be added to the insured parent’s policy. If the parents are both insured and divorced, a court will determine which parent is responsible for insuring baby.
Both parents’/guardians’ policies
Ifthe parents are married and both insured, the baby will automatically receive dual coverage under both policies for the first 30 days of life. After that point, baby may have dual insurance according to the “birthday rule,” which determines an infant’s primary insurance policy based on which parent was born first. A bill introduced to the House of Representatives may eliminate the birthday rule in 2023.
Health Insurance Marketplace Plan
In most states, the U.S. federal government oversees the Health Insurance Marketplace, through which people can shop for and buy private health insurance plans. Some states operate their own Marketplaces.
A Marketplace health plan should cover your new child for the following services without requiring a copay or coinsurance, even if you haven’t yet met your plan’s deductible:
- Behavioral assessments
- Bilirubin concentration screening
- Blood pressure screening
- Blood screening
- Developmental screening
- Fluoride varnish (once baby has teeth)
- Hearing screening
- Hemoglobinopathies or sickle cell screening
- Hypothyroidism screening
- Phenylketonuria screening
- Preventative medication for Gonorrhea
- Risk assessment for oral health
- Tuberculin screening (if baby is at high risk)
- Various immunizations
- Vision screening
- Well-baby visits
Unlike employer-sponsored plans, which typically allow only 30 days for new parents to enroll newborns in their health insurance policies, Marketplace plans give you 60 days to add a new baby to your coverage.
Government-backed Plans
Medicaid and the Children’s Health Insurance Program (CHIP) are tax-funded public insurance programs that cover children. These government-sponsored health plans do not have specific open enrollment periods, meaning you can apply at any time of year through the Health Insurance Marketplace or your state’s Medicaid agency.
If you have a Marketplace health plan when you give birth, when you update your plan to include baby, your provider will tell you if your newborn qualifies for Medicaid or CHIP coverage.
Medicaid
Funded by both state and federal governments, Medicaid plans are administered by states to provide health coverage to low-income Americans, including children. In some states, Medicaid covers all residents whose household incomes fall below 133% of the federal poverty level.
If you have Medicaid upon giving birth, your baby will be enrolled in Medicaid coverage automatically and will remain eligible for at least one year.
Coverage and costs may vary among states, but Medicaid in all states must cover the following:
- Certified pediatric nurse practitioner services
- Early and periodic screening, diagnostic, and treatment services
- Family nurse practitioner services
- Inpatient and outpatient hospital services
- Labs
- Physician services
- Rural health clinic services
- Transportation to receive medical care
- X-rays
CHIP
CHIP works with Medicaid to serve children whose families do not qualify for Medicaid based on income. Each state sets its own qualifications for CHIP. Under CHIP, your baby would receive low-cost health coverage, and you would not need to buy a health insurance plan for your child. If you apply for Medicaid coverage through your state, you should also find out whether your baby qualifies for CHIP.
Like Medicaid, benefits under CHIP differ from state to state. However, all states provide comprehensive coverage through CHIP, including the following services:
- Dental care
- Emergency services
- Inpatient and outpatient hospital services
- Labs
- Prescription medications
- Routine check-ups
- Vaccinations
- Vision care
- Visits to the doctor
- X-rays
Can You Buy Health Insurance For Just Your Newborn?
You can purchase an individual health insurance plan for your new baby either through the Marketplace or directly from a private insurance provider. Alternatively, you can enroll your newborn in CHIP if they are eligible.
Child-only health insurance might be your best bet if you are uninsured, you missed the enrollment period to add your baby to your existing health plan, or your plan does not extend coverage to your dependents.
If your baby qualifies for Medicaid or CHIP, these may be your most cost-effective options that provide robust healthcare coverage for children. If you buy child-only insurance directly from an insurer, you can expect this coverage to be relatively costly.
2. Consider the Costs of Health Insurance For Newborns
You can expect your health plan’s premium to increase after you add your baby. The cost of adding a newborn to your insurance plan varies dramatically based on your policy, the size of your family, and the source of your insurance.
With a Marketplace plan, you can expect your monthly premium to increase by $200 to $300 after you enroll baby. With an employer-sponsored plan, your monthly premium might increase by $400 to $500, but your employer might subsidize a portion of that price.
Family Size | Monthly Premium |
|---|---|
Single Person with No Children | $400-$600 |
Single Person with One Child | $600-$900 |
Single Person with Two Children | $900-$1,200 |
Single Person with Three Children | $1,200-$1,500 |
Couple with No Children | $900-$1,200 |
Couple with One Child | $1,200-$1,500 |
Couple with Two Children | $1,400-$1,600 |
Couple with Three Children | $1,700-$2,400 |
Keep in mind that the data presented here represent average estimates. Your premiums will be dictated by your personal circumstances. Make sure to do your own research or speak with a licensed agent for estimates to see how much you may pay.
Annual Cost of Newborn Health Care
Childbirth alone can cost upwards of $13,000 without insurance, and the expenses keep coming after your baby has entered the world. In their first year of life, your child will need regular well-baby visits, typically at two, 4, 6, 9, and 12 months. Without insurance, it’s possible for each of these visits to cost around $100, and childhood immunizations can exceed $600.
Medical costs vary depending on factors like your geographic location, so if you live in an urban area, you might spend more on baby’s health care. And you will likely incur more medical expenses if you or your baby experience complications during or after birth.
In contrast, with health coverage, childbirth may typically cost you between $5,000-$7,471. For your child’s well-baby visits, you’d probably only owe a copay, and immunizations might be fully covered. This is why it’s critical to ensure your newborn has health insurance immediately after birth.
3. Make Your Insurance Selection
Now that you know your options, it’s time to make a choice. Before committing to a health plan for your baby, ask yourself the following questions:
- Do you and/or your co-parent already have health insurance through an employer? If so, an employer-sponsored health plan might be your best bet, especially if you do not qualify for a government-backed plan. If you are married to your co-parent and you both have insurance, that’s even better—baby can have dual coverage.
- Is your current plan qualified? If you are insured but your plan is not Marketplace-certified, it may not include certain essential health benefits that are necessary for newborns. In this case, consider shopping for a new policy through the Health Insurance Marketplace.
- What’s your income relative to the federal poverty level? If you make less than 200% of the federal poverty level, you may qualify for a government-backed health plan. Medicaid and CHIP provide low-cost health coverage to children, and you might qualify for Medicaid coverage as well.
Select an affordable plan that offers the best possible health benefits for your newborn. Ideally, you should begin research before your child is born.
4. Get Documentation Ready
Once you’ve chosen a plan, it’s time for paperwork. If you’re adding your baby as a dependent to your health insurance policy, you will need to submit enrollment paperwork to your provider. Make sure to do this within the special enrollment period set by your insurer—within 30 days of birth for employer-sponsored plans, or 60 days for most Marketplace plans.
Your insurance provider might request additional paperwork containing critical information about your new child. Keep track of your baby’s birth certificate and hospital records in case your insurer requests these documents. You may also have to provide baby’s Social Security number.
5. Apply and Enroll Baby Into a Health Insurance Policy
When your new child has arrived, it’s time to enroll baby in a health insurance plan. Make sure to do so during your special enrollment period, and try to get your ducks in a row before your baby is born.
When Can You Enroll Your Baby In Health Insurance?
Most insurance providers only allow you to enroll in a health plan during a specific time of year, known as the open enrollment period. But qualifying life events (QLEs) trigger special enrollment periods that allow you to buy into a different policy or add a dependent to your plan outside of open enrollment.
Insurance companies consider childbirth to be a QLE, so once your baby is born, the clock starts ticking for you to make changes to your health insurance policy. Childbirth triggers a 30-day special enrollment period for most employer-sponsored plans. Federal and state insurance plans give you 60 days from birth to add your new dependent.
During this special enrollment period, you can make changes to your own health insurance plan as well. Take this opportunity to research plans and compare benefits and premium costs to make sure you are getting adequate coverage at a reasonable price.
What to Do to Enroll
Adding a newborn to an insurance policy often involves lots of research and paperwork. Read on to learn when you should take each step to enrollment.
Before Baby Arrives
Start researching insurance options before your baby is born. If you are already insured, look at your current plan and compare its costs and benefits to other insurance options. You can find most of the information you’ll need in your policy’s summary of benefits and coverage or its summary plan description.
Make a plan of action for your upcoming special enrollment period; prepare to add your newborn to your current policy or switch policies altogether. If you can, notify your insurer of any changes you plan to make before your new child is born. Advanced notification can make it easier for you to enroll a new dependent, too.
When Baby Arrives
Once your newborn has entered the world, let your insurer know. If you have an employer-sponsored plan, you might reach out to your company’s benefits contact to let them know that your baby has been born and add your baby to your insurance (if applicable). Alternatively, you can reach out to your insurance company directly.
Assemble any paperwork needed to enroll baby in a health insurance policy. These may include:
- Your newborn’s birth certificate or proof of birth
- Baby’s hospital records
- Your child’s Social Security number
Prepare to submit the enrollment paperwork required to add your baby to a health insurance policy.
After Baby Arrives
It’s time to enroll baby. The special enrollment period triggered by your child’s birth should be either 30 or 60 days, depending on whether you have an employer-sponsored plan or a Marketplace insurance plan, respectively. You may enroll your new child in a health plan at any time during this enrollment period.
If you wait a while to enroll your newborn, don’t worry—baby’s coverage is retroactive. This means your child’s coverage is effective starting on their birthdate, even if you enrolled baby a few weeks later. Also, keep in mind that your insurance provider cannot reject your baby for having any preexisting conditions.
6. Receive Confirmation of Coverage
Once you’ve enrolled your newborn in health insurance, the insurance provider should send you a confirmation of coverage letter. This letter typically lists the insurance plan’s effective date and the names of all individuals covered by the plan. Your confirmation of coverage should also detail the plan’s benefits and maximum benefit amounts.
All in All
It’s critical to enroll your newborn in a Marketplace-certified health plan as soon as possible after the baby is born.
Before you meet your new child, make sure to research insurance options and make a plan for the baby’s coverage. If you’re not sure which steps to take first, reach out to your employer’s human resources representative (if you have an employer-sponsored health plan) for a list of action items so you can stay on track before and after your new child is born.
You might research Health Insurance Marketplace plans to ensure you’re getting the best coverage possible for your new baby. And if you’re unable to afford insurance, look into Medicaid and CHIP to see if you’re eligible for a government-backed plan.