Medicaid vs. Marketplace Insurance: Which Covers Your Pregnancy

How Medicaid and Marketplace coverage differ during pregnancy

Medicaid and Marketplace insurance (sold through Healthcare.gov) are two separate programs, and they work very differently when you're pregnant. Medicaid is run by your state and covers people below certain income limits — it has no premiums, no deductibles, and covers prenatal care and delivery with no copays. Marketplace insurance is private coverage you buy through Healthcare.gov or your state's exchange, and it has monthly premiums, deductibles, and copays, though you may receive a tax credit to lower the cost.

The key difference for pregnancy: Medicaid covers the full cost of prenatal visits, ultrasounds, delivery, and postpartum care. Marketplace plans cover these things too, but you pay a deductible first (usually $500 to $2,000 per person), then copays for each visit. If you're pregnant and uninsured, Medicaid is almost always the better choice because it costs you nothing out of pocket.

Key Takeaways

• Medicaid covers all prenatal care, delivery, and postpartum services with no copays or deductibles, while Marketplace plans require you to pay a deductible and copays for each visit.
• Medicaid income limits vary by state, but most states cover pregnant people with incomes up to 138% to 200% of the federal poverty line.
• If you're already on a Marketplace plan when you become pregnant, you can switch to Medicaid during the year if you meet income requirements — you don't have to wait for open enrollment.
• Medicaid coverage continues for 60 days after delivery in most states, giving you time to plan for coverage after that period ends.
• If your income is too high for Medicaid, a Marketplace plan with a tax credit may cost less than you expect.

Medicaid income limits and what "pregnant" means for coverage

Each state sets its own Medicaid income limit for pregnant people. Most states cover pregnant people with household income up to 138% of the federal poverty line (about $1,900 per month for a single person in 2024), but some states go higher — up to 200% or more. A few states have lower limits. You can find your state's exact limit by visiting your state Medicaid office website or calling 211.

Medicaid considers you may be able to access based on pregnancy from the moment you know you're pregnant — you don't need to be a certain number of weeks along, and you don't need a doctor's confirmation to start the process. You can report your pregnancy when you apply, and coverage usually starts the same month you apply or the month after, depending on your state.

When you're already on a Marketplace plan

If you have Marketplace insurance and become pregnant, you can switch to Medicaid at any time during the year — you don't have to wait for the annual open enrollment period in November. This is called a "may have access to life event." Contact your state Medicaid office or your Marketplace plan to report the pregnancy, and ask them to help you switch.

The timing matters because Marketplace plans charge you a deductible before they start paying for care. If you're already several months into a plan year and have paid $1,500 toward a $2,000 deductible, switching to Medicaid means your prenatal visits going forward cost nothing. If you're early in the year, the math is closer, but Medicaid's zero copays usually still win.

What each program covers during pregnancy and after delivery

Medicaid covers all routine prenatal visits, ultrasounds, lab work, delivery (vaginal or cesarean), hospital stay, and postpartum visits with no copays. It also covers mental health care, substance use treatment, and dental care in most states — all things that matter during pregnancy. If you need a specialist, Medicaid covers that too with no referral required in most states.

Marketplace plans cover the same services, but you pay a deductible first, then copays for each visit (usually $20 to $50 per visit). Once you've paid your deductible, you typically pay 20% to 30% of the cost of things like ultrasounds or hospital care. The total out-of-pocket cost can reach $5,000 to $8,000 for a full pregnancy and delivery, even with a tax credit.

After delivery, Medicaid coverage continues for 60 days in most states (some extend it longer). Marketplace coverage continues as long as you pay your premium. If your income changes after the baby is born, you may lose Medicaid may be able to access, so plan ahead for what comes next.

Tax credits and cost if your income is too high for Medicaid

If your household income is above your state's Medicaid limit, you may still get a tax credit on a Marketplace plan that makes the monthly premium affordable. The credit is based on your expected income for the year, and it reduces your premium before you pay it — you don't have to wait until tax time.

To see what a Marketplace plan would cost you, go to Healthcare.gov, enter your income and household size, and look at the plans available. The site will show you the premium after the tax credit is applied. Many people with incomes between 138% and 400% of the poverty line pay less than $100 per month for a plan. However, you'll still have a deductible and copays for prenatal care, so the total cost during pregnancy is higher than Medicaid.

How to apply for Medicaid or switch from Marketplace coverage

To apply for Medicaid, contact your state Medicaid office directly or call 211 and ask for the Medicaid office in your area. You can also apply online through your state's website — search "[your state] Medicaid apply online." Have your Social Security number, proof of income (recent pay stub or tax return), and proof of residency (utility bill or lease) ready.

If you're switching from a Marketplace plan to Medicaid, contact your Marketplace plan first to let them know you're switching, then apply for Medicaid. Your state will handle the coordination. If you're switching from Marketplace to Medicaid, your Marketplace coverage will end when Medicaid starts, so there's no overlap or gap if the timing is right.

If you're on Medicaid and your income increases after the baby is born, you may lose Medicaid coverage. Before that happens, you can switch to a Marketplace plan during the 60-day postpartum period. Contact Healthcare.gov to see what plans are available and what your tax credit would be.

What happens to your coverage after the 60-day postpartum period

Medicaid coverage ends 60 days after delivery in most states. After that date, you'll need different coverage. If your income is still below your state's Medicaid limit for non-pregnant adults (which is usually lower than the pregnancy limit), you may stay on Medicaid. If not, you can switch to a Marketplace plan or your employer's plan if you have one.

Plan ahead by contacting your state Medicaid office about 30 days before the 60-day period ends. Ask whether you'll stay on Medicaid as a regular adult, and if not, ask about switching to Marketplace coverage. You can switch to a Marketplace plan outside the normal open enrollment period if Medicaid ends, so you won't be without coverage.

Frequently Asked Questions

Can I be on both Medicaid and a Marketplace plan at the same time?

No. You must choose one or the other. If you're on Medicaid, you can't also buy a Marketplace plan. If you're on a Marketplace plan and become pregnant, you can switch to Medicaid, but your Marketplace coverage ends when Medicaid starts.

Do I have to pay back Medicaid coverage if my income changes?

No. Medicaid is not a loan. If you receive Medicaid during pregnancy and your income later increases, you don't owe the state money for the coverage you received. However, your coverage will end if your income exceeds the limit, so you'll need to switch to another plan.

What if I'm undocumented or don't have a Social Security number?

Medicaid rules vary by state. Some states cover pregnant people regardless of immigration status; others don't. Call your state Medicaid office or 211 to ask what you need to apply. You may be able to use an Individual Taxpayer Identification Number (ITIN) instead of a Social Security number in some states.

Does Medicaid cover my partner or other family members?

Medicaid covers you and your children if they meet income and residency requirements. Your partner is not covered under your Medicaid. They can apply for their own Medicaid or Marketplace coverage based on their own income and household size.

What if I lose my job while I'm on Medicaid?

Losing your job is a may have access to life event that lets you switch to a Marketplace plan outside open enrollment. However, if you're pregnant and your income drops, you'll likely stay on Medicaid because your income is now lower. Contact your state Medicaid office to report the job loss and ask whether your coverage continues.