Expecting in 2026? Health Insurance Tips for Open Enrollment

We encounter insurance horror stories that are getting attention on TikTok and try our best to explain what happened and possible next steps.

Marshall Darr

Co-founder & CEO

Key Takeaways

If you’re planning to have a baby in 2026, Open Enrollment is the perfect time to make sure you’re financially and medically prepared. A recent TikTok by @sunnylenak highlighted some critical areas expecting parents often overlook (which can make a huge impact on your pocket book):

Short-term disability insurance can provide income replacement during maternity leave or unexpected complications.
Hospital indemnity coverage offers lump-sum payments for hospital stays, including childbirth, and can help offset extra costs.
State paid family leave programs may supplement income during maternity leave, with more states adding programs in 2026.

There’s one piece I wanted to expand upon since it’s also the season where (if you’re covered through the ACA) you can pick a new underlying health insurance plan. Your choice of base health plan on the ACA exchange is incredibly important if you’re expecting to have a child.

The right plan affects your out-of-pocket costs for prenatal care, delivery, postpartum visits, and newborn coverage. Here’s how to approach selecting the best plan for your growing family.

1. Understand Your Maternity Care Needs

Before comparing plans, map out what you expect to need throughout your child birthing process:

Prenatal visits: Most pregnancies require ~12–14 visits.
Ultrasounds, lab work, and tests: Coverage varies widely by plan.
Hospital birth: Check inpatient coverage, delivery type, and newborn care.
Postpartum care: Include lactation support and follow-up visits.

Tip: Confirm that your preferred OB/GYN, hospital, and pediatrician are in-network. Out-of-network care can be extremely expensive.

2. Compare Premiums vs. Out-of-Pocket Costs

Look beyond the monthly premium:

Deductible: The amount you pay before insurance coverage kicks in.
Copays/coinsurance: Check for prenatal visits, delivery, and newborn care.
Out-of-pocket maximum: The most you’ll pay in a year; crucial if complications arise.

Example: A low-premium plan might leave you with high deductibles and coinsurance during delivery. A higher-premium plan with lower out-of-pocket limits may save more money overall.

3. Confirm Maternity and Newborn Coverage

Ensure prenatal, delivery, and postpartum care are fully covered.
Check for any gestational age limits or network restrictions.
Make sure newborn coverage is automatic or easy to add starting at birth.

Some plans also offer telehealth prenatal care or in-hospital cash benefits, which can complement short-term disability and hospital indemnity coverage.

4. Evaluate Additional Benefits

Consider plans that include perks for expecting parents:

Telemedicine for routine questions
Behavioral health support for postpartum mental health
Pediatric care coverage starting at birth
Prescription coverage for prenatal vitamins or pregnancy medications

These benefits can reduce both stress and unexpected costs.

5. Use Total Cost Calculators

Many ACA exchanges and brokers provide total cost calculators, factoring in premiums, deductibles, copays, and expected maternity-related expenses. This is one of the best ways to identify which plan truly meets your needs.

6. Talk to a Broker

People do this for a living and it’s their job to talk you through this decision-making process - for free. If you’re feeling overwhelmed, which is completely reasonable right now given that most people feel overwhelmed while picking a new health plan even when they’re not pregnant, a local broker can be a great resource.

Seriously, use this resource.

Bottom Line

This TikTok rightly points out the importance of disability, hospital indemnity, and state leave programs. But these are just part of the picture. The base health plan you choose on the ACA exchange is the foundation of your coverage. Carefully evaluating network access, out-of-pocket costs, maternity and newborn coverage, and additional benefits can protect your finances while ensuring you and your baby receive the care you need.