Private Health Insurance Now Includes Pregnancy Benefits: A Game-Changer for Families Planning Ahead
For the first time ever, private health insurance plans offered off the Affordable Care Act (ACA) Marketplace are including pregnancy benefits. This is a breakthrough development for families, especially those planning to grow in the next year. At My Private Health Insurance, we’re excited to share how these plans can provide more affordable, flexible, and family-friendly health coverage for individuals and small business owners who want alternatives to the standard government exchange.
Unlike the ACA, where pregnancy is automatically covered but comes with high deductibles and steep out-of-pocket costs, these new private PPO plans offer maternity benefits with much lower out-of-pocket expenses—in many cases less than half of what Marketplace plans require. For healthy individuals who qualify, these plans can make having a baby more financially manageable, while still offering nationwide coverage and provider choice.
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Why This Matters: The Cost of Pregnancy on the ACA Marketplace
Pregnancy and childbirth are among the most expensive health events a family can face. According to the Kaiser Family Foundation, the average cost of childbirth in the U.S. ranges between $13,000 and $20,000, depending on whether it’s a vaginal delivery or C-section. On Marketplace plans, families face a maximum out-of-pocket of nearly $9,000 per year—a financial burden that can be overwhelming.
Even if you’re healthy and rarely use your insurance, the reality is that under ACA coverage you could still be responsible for thousands of dollars in deductibles and coinsurance during pregnancy. That’s on top of monthly premiums, which often run high for middle-class families who don’t qualify for government subsidies.
This is where private, off-exchange plans step in.
The Breakthrough: Pregnancy Coverage Added to Private PPO Plans
Historically, private PPO health plans that were underwritten did not include pregnancy coverage. They were designed to help healthy individuals, families, and small businesses cut premiums and avoid the sky-high costs of ACA plans—but maternity was excluded.
For the first time, this has changed. Select private PPO networks are now offering pregnancy benefits as part of their coverage. While these plans are still medically underwritten—meaning you can’t already be pregnant when applying, and you must be in generally good health—they present a brand-new opportunity for individuals who plan to start or grow their families in the next year.
Imagine locking in comprehensive maternity benefits now, before you’re pregnant, and knowing that your delivery will be covered at a fraction of the cost of a Marketplace plan. That peace of mind is invaluable for couples planning ahead.
Key Advantages of Private Pregnancy Coverage Off the Exchange
1. Lower Out-of-Pocket Costs
The ACA sets its maximum out-of-pocket at around $9,000 per individual (or even higher depending on plan year). With private PPO plans, families often face less than half that amount. That could mean saving thousands of dollars on delivery and newborn care alone.
2. Nationwide PPO Networks
Unlike many Marketplace plans that restrict you to regional HMO networks, these private plans use nationwide PPO networks. That means you can choose your doctors, specialists, and hospitals—including top facilities across the country. For expecting mothers, having the freedom to select a trusted OB-GYN or deliver at a preferred hospital is a huge benefit.
3. Predictable Costs During Pregnancy
Traditional ACA plans often involve high deductibles before coverage even kicks in, leaving families with big surprise bills. Private PPO pregnancy benefits are designed with more predictable copays and lower maximums, helping families budget for one of life’s most important milestones.
4. Great Fit for Healthy Families
Since these plans are underwritten, they’re best for individuals without major pre-existing health conditions. If you’re healthy, self-employed, or running a small business, you may qualify for pregnancy coverage at a far more affordable rate than you’d find on Healthcare.gov.
Who Should Consider This New Benefit?
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Couples Planning to Have a Baby Within the Next Year
If you’re considering pregnancy in the near future, applying now secures your coverage before you conceive. -
Families Priced Out of the ACA
Middle-class families who don’t qualify for subsidies often pay double the premium on the ACA. These private plans can cut costs by 40–60%. -
Self-Employed and Small Business Owners
Entrepreneurs, freelancers, and micro-business owners often struggle with the high cost of Marketplace coverage. Private PPOs now offer an option that balances affordability with comprehensive maternity coverage. -
Those Who Want Provider Freedom
If staying with your doctor or choosing your hospital is a top priority, nationwide PPO access ensures you aren’t locked into narrow networks.
Comparing Costs: Marketplace vs. Private PPO with Pregnancy
To make the difference clear, let’s compare a common scenario:
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ACA Marketplace Plan
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Premium: $1,200 per month for a family of three (no subsidies)
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Deductible: $7,000 per person
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Out-of-Pocket Max: $9,000+
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Network: Limited HMO
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Private PPO Plan with Pregnancy Benefits
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Premium: $700–$800 per month for the same family
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Deductible: Often $1,500–$2,500
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Out-of-Pocket Max: Less than half of ACA, closer to $4,000
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Network: Nationwide PPO
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That’s a potential savings of $10,000 or more over the course of a pregnancy and delivery—without sacrificing quality care.
Addressing Common Questions
Can I apply if I’m already pregnant?
No. These plans require medical underwriting, so you must apply before pregnancy. If you are already expecting, Marketplace plans are your only guaranteed option.
What if I have other health conditions?
These private plans are not designed for individuals with major pre-existing conditions. If you’re managing something like diabetes, cancer, or recent hospitalization, ACA coverage may be a better fit.
Do these plans cover newborn care?
Yes. Just like ACA plans, private PPOs cover well-baby visits, pediatric care, and ongoing family needs.
Will my OB-GYN accept the insurance?
Since these plans use nationwide PPO networks, you’ll have broad provider access—including many of the top facilities and physicians across the U.S.
Why Choose My Private Health Insurance?
At My Private Health Insurance, we specialize in helping individuals, families, and small businesses find affordable, off-exchange private health coverage. Our brokers are licensed nationwide and trained to walk you through all your options—from Marketplace plans to private PPOs with pregnancy benefits.
We understand that planning for a family is one of the most exciting, but also stressful, times of life. Health insurance shouldn’t add to the stress. With our expertise, we’ll help you compare plans side by side, understand your costs, and secure coverage that protects your family without draining your budget.
Taking the Next Step
If you’re planning to grow your family in the next year, the timing couldn’t be better. These private PPO plans with pregnancy coverage are available now—but only for those who apply before pregnancy and qualify through underwriting.
Don’t wait until it’s too late to explore your options. By acting today, you can lock in a plan that provides peace of mind, financial security, and the freedom to choose the care you want for yourself and your baby.
Final Thoughts
For years, expecting parents faced a difficult choice: pay exorbitant Marketplace costs, or go without adequate coverage. Now, for the first time, there’s a third path: private, off-exchange PPO health insurance that includes pregnancy benefits.
At My Private Health Insurance, we believe this is a game-changer for healthy families and small business owners nationwide. With lower out-of-pocket costs, nationwide provider networks, and comprehensive pregnancy coverage, these plans are designed to meet you where you are—and where you’re headed as you build your family.