Pregnancy is one of the most expensive events in American health care. A vaginal delivery without complications costs an average of $13,000 to $14,000, and a C-section averages $22,000 to $25,000, before insurance, according to FAIR Health data for 2025. The ACA changed the economics fundamentally: maternity and newborn care became one of 10 Essential Health Benefits that all individual-market and small-group plans must include, starting in 2014.
This guide covers what ACA plans must pay for in 2026, where gaps remain (grandfathered plans, large employer self-insured plans, short-term plans), how Medicaid fills in for lower-income pregnant people, when you can use a Special Enrollment Period, and what documents you need to enroll before your due date. See KFF's state-by-state Medicaid income limits for pregnant women for exact thresholds in your state.
Coverage Breakdown
| Plan Type | Maternity Coverage Required? | Prenatal Preventive (0 cost) | Labor and Delivery Cost |
|---|---|---|---|
| ACA Marketplace plan (individual or small-group) | Yes | Yes, 0 cost sharing | Covered after deductible and copay (plan specific) |
| ACA-compliant employer-sponsored plan (small group, fully insured) | Yes | Yes, 0 cost sharing | Covered after deductible and copay |
| Large employer self-insured (ERISA) plan | Usually yes (not legally required) | Usually yes | Varies by employer plan design |
| Grandfathered plan (existed before March 23, 2010, unchanged) | No (legally exempt) | No | Plan may exclude maternity entirely |
| Short-term limited-duration plan (STLDI) | No (not ACA-compliant) | No | Maternity almost always excluded |
| Medicaid (pregnancy category) | Yes: prenatal through 60 days postpartum minimum | Yes, 0 cost sharing | Usually $0 to minimal cost sharing for Medicaid beneficiaries |
ACA EHB maternity requirement applies to individual and small-group plans issued on or after January 1, 2014. Large employer self-insured plans fall under ERISA and are exempt from state EHB mandates, though nearly all include maternity voluntarily. Short-term limited-duration plans are exempt from ACA requirements and typically exclude maternity in their contract terms.
Source: HealthCare.gov EHB maternity fact sheet; CMS grandfathered plans FAQ; KFF ACA essential health benefits fact sheet 2026
Direct Answer: What ACA Plans Must Cover for Pregnancy in 2026
Yes. ACA-compliant individual and small-group plans must cover maternity and newborn care as one of 10 Essential Health Benefits. Preventive prenatal visits are covered at zero cost sharing, meaning no deductible, no copay, no coinsurance. That includes regular OB visits, folic acid, iron screening, gestational diabetes screening, preeclampsia screening, and breastfeeding support. Labor, delivery (both vaginal and C-section), postpartum care, and newborn care in the hospital are covered but go against your deductible and cost-sharing obligations for 2026.
- Preventive prenatal visits: covered at 0 cost (no deductible, no copay)
- Folic acid supplementation: covered at 0 cost
- Gestational diabetes screening: covered at 0 cost
- Preeclampsia prevention with low-dose aspirin: covered at 0 cost
- Labor and vaginal delivery: covered, subject to deductible and copay
- C-section: covered at the same cost-sharing rate as vaginal delivery
- Postpartum (follow-up) care: covered
- Newborn care: covered under the mother's plan for 30 days after birth
- Breastfeeding counseling and breast pump equipment: covered at 0 cost
What Original ACA Plans Do NOT Cover for Pregnancy
ACA coverage for pregnancy has real gaps even in fully compliant plans. Cost sharing (deductibles, copays, coinsurance) still applies to non-preventive services. A 2026 marketplace Silver plan typically carries a deductible of $3,000 to $6,000 for an individual, meaning the first several thousand dollars of hospital charges for labor and delivery come out of your pocket before insurance pays. After the deductible, you pay coinsurance (often 20% to 30%) until hitting the plan's out-of-pocket maximum.
Services commonly NOT covered or limited: elective private room upgrades, fertility treatments (IVF is not an EHB), cord blood banking, non-medically-necessary prenatal genetic testing panels, and cosmetic procedures performed during delivery. Midwife care and home birth coverage vary by plan and state. Always check your plan's Summary of Benefits and Coverage (SBC) before your due date.
Plans That Are NOT Required to Cover Maternity in 2026
Three categories of plans are legally exempt from the ACA EHB maternity requirement. First, grandfathered plans: plans that existed before March 23, 2010, and have not made significant changes (raising cost sharing, cutting benefits, switching insurers) are grandfathered and may exclude maternity entirely. Very few plans still hold grandfathered status as of 2026 because most have made benefit or cost changes since 2010, but if you think your plan might be grandfathered, your insurer is required to say so in plan documents.
Second, large employer self-insured (ERISA) plans: companies that self-fund their health benefits are governed by federal ERISA law, not state insurance rules. ERISA preempts state EHB mandates, so large self-insured employers are technically free to design maternity benefits however they choose. In practice, nearly all large employers cover maternity because it's standard in employer plan design and required under federal sex discrimination rules (the Pregnancy Discrimination Act), but the benefit level and cost sharing vary. Third, short-term limited-duration insurance (STLDI) plans: STLDI plans are not ACA-compliant insurance. They are governed by separate federal rules and almost universally exclude pregnancy and maternity care in their policy terms. Do not rely on a short-term plan if you are pregnant or planning to become pregnant.
Medicaid for Pregnancy: Higher Income Limits and Broader Coverage
Medicaid has a dedicated pregnancy category that is more generous than regular adult Medicaid in most states. While adult Medicaid in the 40 expansion states covers individuals up to 138% of the 2026 federal poverty level ($22,025 for a household of one), most states cover pregnant people at 196% to 213% FPL. California covers pregnant people up to 213% FPL. Texas covers them up to 203% FPL. Many states exceed that floor. This means that even in expansion states, some pregnant people who would not qualify for regular adult Medicaid do qualify under the pregnancy category.
Medicaid pregnancy coverage typically begins from conception and continues through 60 days postpartum at minimum. The American Rescue Plan Act extended postpartum coverage to 12 months postpartum in states that opted in, and as of 2026, the majority of states have adopted that 12-month extension. Medicaid pregnancy coverage includes all prenatal visits, lab tests, ultrasounds, labor and delivery (vaginal and C-section), newborn care, and postpartum mental health services. Cost sharing for pregnant Medicaid beneficiaries is typically $0 or nominal. CHIP programs in many states also cover pregnant people through a separate perinatal coverage option.