Health Insurance Basics

If you’re pregnant

All health insurance plans that count as qualifying health insurance cover pregnancy and childbirth related services. Maternity care and childbirth are one of the 10 essential benefits required on qualifying health plans under the ACA. These services are covered even if you became pregnant before your coverage starts. (For most health insurance plans, you can find the specific way your plan covers childbirth on page 7 of your Summary of Benefits and Coverage document.)

Having a child counts as a qualifying event for a special enrollment period in which you can enroll in a new plan or switch plans. (In the state of New York, becoming pregnant also qualifies you for a special enrollment period.)

Maternity care and childbirth are also covered by Medicaid and CHIP. If you qualify for Medicaid and CHIP and are pregnant, you can apply at any time during the year through your state agency or marketplace.

If you’re a senior citizen

If you’re above the age of 65, you qualify for Medicare. We go into more detail into Medicare below, but the gist of it is that it’s a federal program designed to help you cover health care costs into old age.

You can also purchase supplemental insurance, called Medigap, that can help pay for your deductibles, copayments, and coinsurance. Medigap plans may or may not make sense for you – make sure you know what you’re buying before you start to pay for it.

If you’re currently in the military

If you’re an active duty service member, your health care (and your family’s health care) is covered by TRICARE. You do not need to purchase additional health insurance to comply with the ACA.

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