Health Insurance Companies that Offer Coverage for Pregnancy in Texas 

In 2022, seventy-nine percent of adult women 19 to 64 had some form of health insurance in Texas, whether it be employer-sponsored, directly purchased, Medicaid, or another source. That compares to the 58.4 percent of men who had health insurance. The reason for the difference is evident. A woman’s body needs more care than a man’s does. Primarily when it comes to their reproductive capability. Pregnancy is not easy, and a doctor, gynecologist, obstetrician, hospital, and pharmacist all play crucial roles in childbirth. A mother wants the best for her baby, or in some cases, babies. So, she will want to know which health insurance company offers the best coverage for pregnancy in Texas. We at CoverMile are here to deliver that information.

Does Health Insurance Cover Pregnancy?

According to the Affordable Care Act, there isn’t much that health insurance does not cover. Health insurance companies cannot exclude or rate an individual due to a medical condition even if they sign up for health coverage with a diagnosis that predates the insurance application. This includes pregnancy.

With all insurance companies covering pregnant women in Texas, it then becomes how they deliver that care. Are there differences between the insurance companies? First, let’s take a look at insurance itself.

Health insurance companies are separated into networks. While normally you will need to work within your network or risk not being covered, pregnancy is a bit different. It is important to know that these exist, however.

HMO, PPO, EPO (Health Maintenance Organizations, Preferred Provider Organization, and Exclusive Provider Organization) – These are the three primary networks insurance companies use to coordinate medical benefits. EPOs are the strictest; you must remain within your network, or you will not receive coverage; HMOs, you can go out of network with their permission; PPOs allow you to see any doctor you wish without preauthorization, but you may receive reduced benefits if they are out of network.

We will discuss in a moment how health insurance for pregnant women is different for all network levels.

Pregnancy and the Affordable Care Act

Before we talk about insurance, there are a few things you need to know about how the ACA treats pregnancy. The first thing is that if you do not have health insurance and you become pregnant, it does not trigger a Special Enrollment Period. However, if you are already pregnant and you give birth, that does. Your only option for health care when you do not have insurance and are pregnant is Medicaid. Another is that if you currently have coverage under a parent’s health insurance policy, your prenatal care may be covered, but your child would not be. They would need their own health insurance.

Finally, you may wonder about having two doctors, your Primary Cary Physician (PCP) and your Obstetrician-Gynecologist (OBGYN). As we discussed earlier, insurance companies work with networks. These doctors require referrals to see specialists. Under most circumstances, an OBGYN would be regarded as a specialist. However, under the Affordable Care Act, you have the right to see an OBGYN without a referral, even to make them your PCP.

Now that we have some background on health insurance for pregnant women, let’s take a look at insurance companies in Texas that offer coverage.

Health Insurance Companies that Cover Pregnancy in Texas 

Below, we have selected four of the best health insurance companies that cover pregnancy and broken them down by what they offer expecting mothers and future families.

Aetna

Aetna is available in 41 Texas counties and offers Medical, Dental, and Vision Insurance. They are required under the ACA to cover pregnancy, maternity, and newborn care. Aetna’s pregnancy care is called the Aetna Maternity Program. It aids members from the family planning stages through postnatal care.

During Pregnancy

A member receives care from experienced nurses and medical professionals, including doctors and pharmacy coordinators, who coordinate medication safety. Out of office, they are educated through the process, receive testing to determine health risks, and receive one-on-one counseling when needed. Text4baby is a service with health reminders and aids on care nutrition. Office visits are covered at no charge.

During Hospital Stay

Childbirth and delivery services are covered at a coinsurance, depending on the plan you select. If any of your services are out of network, other than an emergency, you do not have coverage.

Post Delivery

The care management and rewards program is called the PROMISE program. Earning rewards for completing steps like keeping your doctor visits. Also included are classes that assist with coping with life as a mother, including breastfeeding, being a working mom, or postpartum depression.

Blue Cross Blue Shield of Texas

Blue Cross Blue Shield of Texas is the second largest company in this review in terms of network size. They are available statewide. They offer Medical, Dental, and Vision plans. They are an HMO, which means you need to stay within your network, or you will not have coverage and need a referral to see a specialist. However, as the ACA states, you do not need a referral to see an OBGYN or to make them your PCP.

During Your Pregnancy

Visits to your Primary Care Physician for your pregnancy will be on a copay basis, as will your visits to your OBGYN on the Specialist tier. Copays and coinsurance vary depending on the plan you select. If you also receive Medicaid (Blue Cross Blue Shield of Texas STAR), you receive additional benefits: Prenatal classes, an Incentive gift card for attending your doctor visits, and free items such as an infant car seat.

During Your Hospital Stay

Childbirth and delivery services are covered at a coinsurance, depending on the plan you select. If any of your services are out of network, it will depend on the plan you have as to if you have coverage. If you do have coverage, it would be reduced. Blue Cross Blue Shield of Texas does not allow at-home births, but they do allow doulas in the birthing room.

Post Pregnancy

Blue Cross Blue Shield of Texas STAR will also give you an Incentive Card when you complete postpartum visits. They also have a Special Beginning program that assists new mothers adjust education in such things as breastfeeding. Postpartum depression is also a struggle for many women. BCBS of Texas has a program set up for new moms on how to obtain help.

Cigna

Cigna is a smaller company that is only available in eleven counties that surround major cities such as Dallas and Ft. Worth, Lubbock, and El Paso. They are expanding to include Austin, Houston, and San Antonio offering medical, dental, and vision insurance to pregnant women in Texas. They are an HMO and a PPO.

During Your Pregnancy

OBGYN care does not charge a copay for the office visit. This portion of your insurance is coinsurance-based, depending on the plan you select. This can vary depending on the cost the doctor’s office itself charges. However, this charge cannot be different for each individual. Healthy Pregnancies, Healthy Babies is a program that assists expecting mothers with preparing them for their treatments and delivery and encouraging them to better behaviors such as eating healthier and smoking cessation.

During Your Hospital Stay

Office visits and childbirth and delivery services are covered at a coinsurance, depending on the plan you select. If any of your services are out of network, they are not covered unless they are in an emergency. One benefit that Cigna has that many other insurance companies don’t is non-emergency-based home birth by a licensed midwife.

Post Pregnancy

Continued education on baby development and life adjustment, including postpartum depression.

UnitedHealthcare

UnitedHealthcare is now the second largest healthcare provider in Texas, covering 209 of the 254 counties. UHC is an HMO and has five plan tiers with each health insurance shopper in mind, depending on a family’s needs. Essential has the highest deductible and the lowest cost; Advantage has the highest cost and the lowest deductible.

During Your Pregnancy

UnitedHealthcare offers expecting mothers Healthy First Steps. This program helps them adjust to the thought of being a mom. They help with providing an expected due date, physical exams and tests, and ultrasounds. OBGYNS also guide you with prenatal care like guiding you with healthy eating and quitting habits such as smoking cessation.

During Your Hospital Stay

Childbirth and delivery services are covered at a coinsurance, depending on the plan you select. UnitedHealthcare is an HMO, so if any of your services are out of network, other than an emergency, you will not have coverage. UHC allows both mid-wife and doula services. Midwife services are permitted for at-home deliveries.

Post Pregnancy

Postpartum care is also provided to help adjust to life with your newborn. This includes pain recovery and emotional health, including postpartum depression.

How Can I Sign up for Pregnancy Health Insurance?

As a reminder, if you do not have health insurance, becoming pregnant does not trigger a Special Enrollment Period; the delivery does. There are only eight states where the pregnancy itself triggers an OE period, and these are states with a state-run exchange system. Unfortunately, Texas is not on this list. You do have options for health care.

Medicaid – State-run exchanges have recently changed. Federal law chose to expand Medicaid; however, Texas was one of 11 states that chose not to. While this does not affect being pregnant and delivery, it does affect the mother’s coverage post-pregnancy. Texas law gives mothers care for up to twelve months postpartum. After this, your pregnancy no longer qualifies you to remain on Medicaid. You would need to requalify based on income to continue services.

Parent’s job – If you are under 25 and covered under your parent’s health insurance policy, then your OBGYN visits, delivery, and postpartum visits for you are covered. However, any doctor visits for your child would not be. They would need their own insurance policy; this includes immunizations and well-checkups.

At CoverMile, we help individuals, families, and pregnant women find the best health insurance at a price they can afford. Contact us today and begin the process of signing up.