Having a Baby? Health Insurance Checklist for New Parents

What ACA plans cover for pregnancy and newborns

Maternity and newborn care is one of the ten essential health benefits that all ACA-compliant plans must cover. That includes prenatal visits, lab work, ultrasounds, labor and delivery (vaginal and C-section), complications, and postpartum care. These aren't optional add-ons. Every Bronze, Silver, Gold, and Platinum plan on the marketplace covers them.

Preventive prenatal services are covered with no cost-sharing. That means your routine prenatal visits, gestational diabetes screening, anemia testing, and genetic screenings have no copay or deductible. The same goes for well-baby visits after birth: immunizations, developmental screenings, hearing tests, and growth checks are all covered at $0 out of pocket.

The delivery itself is not preventive, though. You'll pay your plan's deductible and coinsurance for the hospital stay. The average out-of-pocket cost for a vaginal delivery with insurance is around $2,600, and a C-section runs closer to $3,100. Your actual cost depends on your plan's deductible and coinsurance rates. In 2026, the out-of-pocket maximum for an individual marketplace plan is $10,600, so no matter how complicated the birth gets, your costs are capped.

One thing to watch: short-term health plans and grandfathered plans are not required to cover maternity care, and most don't. If you're planning a pregnancy, make sure you're on an ACA-compliant plan before you conceive. Pregnancy itself is not a qualifying life event for a Special Enrollment Period.

The 60-day enrollment window

Birth and adoption are both qualifying life events that trigger a 60-day SEP. During those 60 days, you can:

• Add your baby to your existing marketplace plan
• Switch to a different plan entirely (different metal tier, different insurer)
• Enroll in a marketplace plan for the first time if you weren't covered before

The unique part: when you add a newborn to a marketplace plan, the baby's coverage is retroactive to the date of birth. So if your baby is born on March 10 and you don't get the paperwork done until April 5, the baby is still covered from March 10 onward. The hospital bills from the delivery and any NICU time are included.

You do not need a Social Security number for your baby to start the enrollment process. You can begin the application and update it with the SSN once it arrives (it usually takes 4-6 weeks).

How a new baby changes your subsidy

Adding a child increases your household size by one. Your income stays the same, but the federal poverty level threshold goes up. For a family of three, 100% FPL is $26,650 in 2026, compared to $21,150 for a family of two. That means a lower percentage of FPL at the same income, which usually means a bigger subsidy.

For example: a couple earning $60,000 with no children is at about 284% FPL (household of 2). Add a baby and the same $60,000 income drops to about 225% FPL (household of 3). That lower FPL percentage increases your premium tax credit and may also qualify you for cost-sharing reductions on Silver plans (available below 250% FPL).

This is important to act on. Many parents don't realize that reporting the new household member can meaningfully lower their monthly premium. Update your marketplace application as soon as possible after the birth.

Want to find a plan that covers your OB-GYN and pediatrician? Ask Nora — she'll check provider networks and find plans with the best maternity coverage in your area.

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Adding baby to your plan vs. getting a new plan

You have two paths, and which one is better depends on your situation.

Adding to your existing plan

This is simpler. Your baby joins your current plan, same network, same deductible structure. The premium goes up because you're covering an additional person, but your subsidy should also increase once you report the new dependent. The baby shares your plan's deductible and out-of-pocket maximum.

Switching to a new plan

The birth SEP lets you change plans entirely. This might make sense if:

• Your current plan has a narrow network that doesn't include the pediatrician you want.
• You were on a high-deductible Bronze plan and now want a Silver plan with lower cost-sharing for the many doctor visits that come with a new baby (well-baby checkups alone happen at 1, 2, 4, 6, 9, and 12 months).
• Your household size change makes you newly eligible for CSR Silver plans, which have much lower deductibles and copays.

If you switch plans mid-year, be aware that any spending toward your old plan's deductible does not carry over to the new plan. You start fresh. For a family that just had a baby and already hit part of their deductible from the delivery, this trade-off needs consideration.

CHIP: another option for the baby

The Children's Health Insurance Program covers kids in families that earn too much for Medicaid but may still need help affording coverage. Income limits vary by state, but most states cover children in families earning up to 200-300% FPL. Some states go as high as 400% FPL.

If the mother was enrolled in Medicaid or CHIP during pregnancy, the newborn is automatically deemed eligible for coverage from birth through age one, with no separate application required. This is federal law, not a state option.

CHIP premiums are very low (often $0-$50/month) and copays are minimal. Even if you keep yourself on a marketplace plan, putting the baby on CHIP can be a smart way to save. CHIP enrollment is open year-round with no enrollment period restrictions.

Checklist for the first 60 days

1. Report the birth to the marketplace. Log into HealthCare.gov (or your state exchange) and report a life change. Select "had a baby" and enter the birth date. Do this as soon as possible, even before you have the baby's SSN.
2. Decide: same plan or new plan. Review whether your current plan still makes sense. Check if your new household size qualifies you for CSR. If it does, a Silver plan could save you hundreds in out-of-pocket costs over the year.
3. Check CHIP eligibility. Visit InsureKidsNow.gov or call 1-877-543-7669 to check whether your baby qualifies. You can enroll in CHIP at any time.
4. Update your income estimate. If you or your partner will take unpaid leave or reduce hours after the birth, your household income for the year may be lower than originally projected. A lower income estimate means a larger subsidy. Update it on your marketplace application.
5. Pay your updated premium. After adding the baby, your monthly premium will change. Make sure you pay the new amount to keep coverage active. If you underpay, you risk a lapse.
6. Schedule well-baby visits. Pediatric visits at 1 week, 1 month, 2 months, 4 months, 6 months, 9 months, and 12 months are covered at no cost as preventive care. Find an in-network pediatrician and book the first appointment before you leave the hospital.