Thanks to the Affordable Care Act, maternity coverage is now a required benefit on all individual and small group health plans. Pregnancy can no longer be treated as a pre-existing condition, and many preventive services are covered at no additional cost. Here's what you need to know about maternity coverage in North Carolina.
If you're thinking about having a baby or are already pregnant, understanding your health insurance options is essential. The good news: all Marketplace plans and most employer-sponsored plans now include maternity coverage as a standard benefit.
The Affordable Care Act (ACA), which took full effect in January 2014, transformed maternity coverage in the United States. Before the ACA:
90% of individual health plans didn't include any routine maternity benefits
Pregnancy was considered a pre-existing condition that could result in denied coverage
Women were charged significantly higher premiums than men for the same coverage
If maternity coverage was available, it was often sold as an expensive add-on with waiting periods
Today, maternity and newborn care are among the 10 "essential health benefits" that all ACA-compliant plans must cover. This includes all individual and small group plans sold through the Marketplace and off-exchange. Pregnancy cannot be used to deny coverage or charge higher premiums, and women cannot be charged more than men for the same plan.
Maternity coverage under ACA-compliant plans typically includes care throughout your pregnancy, during delivery, and after your baby is born:
Prenatal Care (Before Birth):
Routine prenatal visits with your OB-GYN or midwife
Screenings for gestational diabetes, anemia, Rh incompatibility, and genetic conditions
Lab tests and bloodwork
Ultrasounds and imaging
Folic acid supplements
Tobacco cessation counseling for pregnant women
Infection screenings (urinary tract infections, hepatitis B, sexually transmitted diseases)
Preconception care and well-woman visits
Labor and Delivery (Inpatient Services):
Hospitalization for delivery (vaginal or cesarean)
Physician and midwife fees
Anesthesia (epidural)
Medications
Coverage for delivery complications
After Birth (Postpartum and Newborn Care):
Postpartum visits and check-ups
Lactation counseling and support
Breast pump (covered at no cost under preventive services)
Screening and support for postpartum depression and anxiety
Newborn care immediately following birth
Newborn immunizations, hearing tests, and metabolic/genetic screenings
Well-baby check-ups
Important: Many prenatal and postpartum preventive services are covered at no cost (no copays, deductibles, or coinsurance). However, other services, such as hospitalization for delivery, may be subject to your plan's deductible, copays, and out-of-pocket limits. Always check your specific plan's Summary of Benefits for details.
While the ACA requires most plans to cover maternity, there are some exceptions:
Grandfathered plans: Health plans that existed before the ACA was passed and haven't significantly changed are not required to cover maternity care. These are increasingly rare.
Short-term health insurance: Short-term plans are not ACA-compliant and rarely cover maternity care. They can also deny coverage for pre-existing conditions, including pregnancy.
Health sharing ministries: These are not insurance and are not required to cover maternity care.
Large group plans (dependent coverage): While large employer plans must cover maternity for employees, they're not required to cover maternity for dependent children.
If you're planning to become pregnant, make sure you're enrolled in an ACA-compliant plan that includes maternity coverage before you get pregnant. Pregnancy is generally NOT a qualifying event for a Special Enrollment Period in most states, including North Carolina.
Open Enrollment Period:
You can enroll in a Marketplace health plan or make changes to your existing coverage during the annual Open Enrollment Period:
2026 coverage: November 1, 2025 – January 15, 2026
Enroll by December 15, 2025, for coverage starting January 1, 2026
Enroll by January 15, 202,6 for coverage beginning February 1, 2026
Special Enrollment Periods:
Outside of Open Enrollment, you can only enroll in or change health plans if you experience a qualifying life event. Important things to know:
Pregnancy is NOT a qualifying event in most states, including North Carolina. This means you cannot sign up for coverage simply because you become pregnant.
Having a baby IS a qualifying event. Once your baby is born, you have 60 days to enroll in a new plan or add the baby to your existing coverage. You, your spouse, and your other children can also enroll or change plans during this window.
Other qualifying events that trigger a Special Enrollment Period include losing other coverage, getting married, moving, and changes in household income that affect subsidy eligibility.
Bottom line: If you're planning to have a baby, enroll in an ACA-compliant plan during Open Enrollment BEFORE you become pregnant. Don't wait until you're pregnant to try to get coverage.
If you have limited income, you may qualify for Medicaid coverage during pregnancy. Unlike Marketplace plans, you can apply for Medicaid at any time—there's no Open Enrollment requirement.
Key Points About NC Medicaid for Pregnancy:
Medicaid finances about 40% of all births nationally
Pregnant women can qualify at higher income levels than the general Medicaid population
Coverage includes prenatal care, delivery, and postpartum care with no cost-sharing
If your baby is born while you're on Medicaid, they're automatically enrolled in Medicaid coverage
12-Month Postpartum Coverage in North Carolina:
North Carolina has extended Medicaid postpartum coverage from 60 days to 12 months after delivery. This means if you qualify for Medicaid during pregnancy, you'll have continuous coverage for a full year after your baby is born—giving you access to postpartum check-ups, mental health support, and ongoing care during this critical period.
As of 2025, 47 states plus Washington D.C. have implemented this 12-month postpartum extension, which was made permanent by the Consolidated Appropriations Act of 2023.
There are several ways to find affordable maternity coverage in North Carolina:
1. Check if you qualify for premium subsidies:
If you purchase coverage through the Health Insurance Marketplace (HealthCare.gov), you may qualify for premium tax credits that lower your monthly costs. Subsidies are based on your household income and the cost of plans in your area. Many people qualify for plans with premiums of $10 or less per month.
2. Check if you qualify for Medicaid:
Pregnant women in North Carolina may qualify for Medicaid at higher income levels than the general population. Medicaid provides comprehensive maternity coverage with no premiums and no cost-sharing for most services.
3. Compare plans carefully:
All ACA-compliant plans cover maternity, but costs can vary significantly. When comparing plans, look at the total potential cost—including monthly premiums, deductibles, copays, and out-of-pocket maximums. A plan with a higher premium but lower deductible may actually save you money if you're planning a hospital delivery.
4. Check your provider network:
Make sure your preferred OB-GYN, midwife, and hospital are in the plan's network. Going out-of-network can significantly increase your costs.
Our team of knowledgeable and local health insurance agents can help you find the right health plan for your family, including plans with comprehensive maternity coverage. We can help you:
Compare Marketplace plans and check for subsidy eligibility
Understand the differences between plan types (Bronze, Silver, Gold)
Verify that your doctors and hospital are in-network
Enroll during Open Enrollment or a Special Enrollment Period
Understand your options if you're already pregnant