The Affordable Care Act, women, and families

The Affordable Care Act (also called the ACA, or Obamacare) provides Americans with new options for health insurance (also called health coverage or health plan).

The law sets new rules for the types of health services a health plan offers and what you have to pay for those services. Certain services may be important to you if you are pregnant, thinking about becoming pregnant, or already have children. Finding out what different plans cover and how much they cost can help you choose a plan that’s right for you and your family.

If you are a woman of childbearing age (18 to 44 years old), how does the ACA affect your health care?

The ACA says that all health insurance plans must fully cover preventive care services for women with no copay. Those are services like immunizations and screening tests that can help prevent certain health conditions or find them early so you can start treatment. For example, you can get a routine gynecological checkup, breast cancer screening, or get birth control without a copay. The copay is the money you pay for each health service you receive, such as a visit to a health professional.

The ACA also makes sure you can see a women’s health professional without needing a referral from your primary care doctor. Women’s health services include, for example, birth control, breast cancer screening, and prenatal care. You do not need to see your primary care doctor (the professional who provides basic health services) first before you can see a professional who specializes in women’s health, such as an obstetrician/gynecologist (also called an OB/GYN), a nurse-midwife or a nurse practitioner.

If you are pregnant or thinking about becoming pregnant, how does the ACA affect your health care?

Ideally, you should find out and treat health problems before you get pregnant. Some health problems, such as high blood pressure and diabetes, can cause problems during pregnancy.

This law states that health plans must cover many services for pregnant women, including:

All prenatal care visits with no copay. Prenatal care is the medical care a woman receives during pregnancy. No copay means you don’t have to pay your provider every time you get a checkup.
delivery services
Breastfeeding assistance with no copay. This includes visits to the lactation consultant, breastfeeding equipment, and breast pumps. A lactation consultant is someone with special training to help women who are breastfeeding.

When choosing a health plan, review the plan summary. Each plan has a summary that includes the expected pregnancy costs for that plan. Each summary uses the same format, so it’s easy to compare costs and services. Plan summaries are available on the Health Insurance Marketplace.

Some pregnant women need help paying for health insurance. In most states, pregnant women can get Medicaid coverage even if they earn more than other low-income adults. Medicaid is a government program that offers free or low-cost health insurance for people with low incomes. In some states, pregnant women who earn too much for Medicaid may be covered by the Child Health Insurance Program (also called CHIP). CHIP is a government program that provides health insurance to children in certain low-income families. If you’re shopping for insurance on the online Health Insurance Marketplace and the application says you’re pregnant, you’ll get specific information about these and other pregnancy health plans.

If you have children, how does the ACA affect your children’s health care?

The ACA says that health insurance plans must cover certain health services for children, including:

Children ‘s well-child visits with no copay. These are the medical checkups that your child has when he or she is not sick. No copay means you don’t have to pay your child’s provider every time you take your child in for a checkup.
Vaccination without a copay. These are shots given to your child to protect against certain diseases.
Visits to a health professional when your child is sick.

Your child can stay in your health plan until age 26 even if they no longer live with you or are married. If your son is not covered by her insurance now, she may be able to add him to her plan. But she must add it within a certain period. Check with your health insurance plan about adding older children to your coverage.

If you get health insurance through your employer, chances are you can get family coverage. This is a plan that protects you, your partner, and your children. But it can be confusing to ask for help paying for insurance for your children. Sometimes children can get coverage that is not offered to their parents. Some states have health plans that only cover children (called child-only plans). Sometimes children in the same family have different types of coverage depending on their age.

If your child has special health care needs, how does the ACA affect their health care?

The ACA can help ensure that children with special health care needs have the health insurance they need to pay for services and treatment throughout their lives. For example:

Health insurance plans cannot deny coverage or charge you more money for a child with a pre-existing condition. This is a health problem your child has before you sign up for health insurance.
Health insurance plans cannot set a lifetime limit on health insurance. That means the health plan can’t say it only pays for services up to a certain amount of money. The plan must cover the child’s medical treatment for as long as the child is covered by the plan.
Health insurance plans must set a cap (limit) on your annual out-of-pocket costs. Out of pocket means the amount of money that you must pay for health services. Health plans must set an annual limit on the amount you spend out of pocket for medical care each year. Once you reach that limit, your health plan pays for your health services in full.
Medicaid can help some children with wrap-around services. In some states, children with special health care needs covered by private plans can get Medicaid coverage. That coverage is called comprehensive service. In those cases, Medicaid may cover services not covered by the private plan. Or you can pay for more visits to the professional than the private plan allows.

Your child’s health may affect which health insurance plan you choose. If your child has a medical problem, you’ll want to choose a plan that covers your child’s provider or prescription drugs. And if your child has a problem that requires special dental or vision care, you’ll want to choose a plan that covers those services. Some plans pay for children’s vision and dental services, while others have limited coverage. See the plan summary for a list of costs and coverage for children’s eye exams, glasses, and dental checkups.