How to add a new baby to your health insurance
It’s easy to forget about insurance paperwork after your baby’s born. After all, there’s an awful lot going on. However, adding your baby to a health plan has a deadline, and missing it can leave your little one without coverage for months. Here's what to do, and when.
Key takeaways
- The birth of a baby is a "qualifying life event" that lets you change your health coverage outside open enrollment.
- Employer plans usually give you at least 30 days after the birth to add your baby. Marketplace plans give you 60 days.
- Coverage usually goes back to your baby's date of birth if you add the baby on time.
- A baby born to a mother on Medicaid is automatically covered for their first year.
Your baby needs coverage from day one. Newborn care, hospital stays, checkups, and vaccines all cost money, and some babies need extra care in the first weeks.
If you have insurance through work
Call your HR or benefits department, or log in to your benefits website, as soon as you can after the birth. A lot of plans give you 30 days, but some give you longer.
- You'll usually need: Your baby's full name and date of birth, Social Security number, or a note that you've applied for one, and sometimes a copy of the birth certificate or hospital record
- Choosing a plan tier: If you're on "employee only" coverage, you'll need to move to "employee plus child" or "family" coverage. Your premium will go up, so ask how much.
- Choosing whose plan: If you and the other parent have insurance from employers, compare the costs of adding the baby to each plan.
If you have marketplace coverage
If you bought insurance through HealthCare.gov or a state marketplace, report the birth within 60 days. You can add your baby to your current plan or choose a new plan for the family.
Adding a child changes your household size, which may make you eligible for more help with premiums. Update your application to find out.
If you have Medicaid
If you're on Medicaid when your baby is born, your baby is automatically eligible for Medicaid for their first year. You still need to let your state Medicaid agency know about the birth so your baby gets an ID card. Most hospitals help with this before you go home.
If you don't have coverage
Your baby may qualify for Medicaid or CHIP, the Children's Health Insurance Program, even if you don't. CHIP covers children in families that earn too much for Medicaid but can't afford private insurance. Income limits for children are much higher than for adults in every state. You can apply anytime through your state Medicaid agency or HealthCare.gov.
What happens if you miss the deadline?
If you miss your window, you may have to wait until the next open enrollment to add your baby. That could leave your child uninsured for months, and you could get stuck with serious bills for newborn care.
If you've missed the deadline, call your plan right away and ask about your options. If your baby qualifies for Medicaid or CHIP, you can apply anytime.
Pick a pediatrician who's in network
Your baby will have several checkups in the first year, usually covered at no cost when you use an in-network doctor. Check your plan's directory, or call the pediatrician's office to make sure they take your insurance, before your baby's first visit.
After you add your baby
Once your baby is added:
- Watch for a new insurance card for your baby, or an updated family card.
- Check your first explanation of benefits to make sure claims are being paid.
- Rework your budget to accommodate the higher premium.
- Make sure your deductible and out-of-pocket maximum are updated.
What this is
Why it matters
What it means for you
What to do next
Sources
Related FAQs
Common questions about this topic, answered simply.
What if my baby doesn't have a Social Security number yet?
You can usually add your baby without one and send the number later. Ask your plan.
Does adding a baby raise my deductible?
If you move from individual to family coverage, you'll usually have a family deductible, which is higher.
Do the same rules apply if we adopt?
Yes, adopting a child, or having a child placed with you for adoption, also opens a special enrollment window with similar deadlines.
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