A parent’s guide: How to choose a health insurance plan and get clear on employer benefits
Navigating the health insurance system in the U.S. is complex — especially if you’re a parent. Health insurance benefits vary state by state, and too often, the system falls short for those who must navigate prenatal to postpartum care.
That’s why parents (and working parents) in particular must be their own advocate. Employer-sponsored healthcare is the primary way parents receive benefits, and too often, maternity leave (if offered at all) is assumed to be enough to assist parents who require care for themselves and their newborns.
That’s why being your own advocate is non-negotiable, especially before your baby arrives. You deserve a plan that works for you, not one where you’re left guessing what’s covered. The insurance-covered International Board Certified Lactation Consultants at The Lactation Network are in your corner, pushing for policies that hold insurance companies accountable. We fight to ensure you get the benefits you’re entitled to.
Learning about your insurance options isn’t a complicated waste of time; it can empower you to make an informed choice about your breastfeeding care. And when it comes to breastfeeding care, you and your family deserve the best.
Does your health insurance truly cover postpartum care?
A lot of insurance plans say they cover postpartum care, but what does that really mean? One follow-up OB visit? Some vague breastfeeding support while you’re still in the hospital? It’s up to you to ask about what happens after you leave — will you have access to resources like an IBCLC, breast pump coverage, and mental health resources? Don’t assume those benefits are automatic. Get clear on the details so you don’t get caught off guard.
We want to be clear that postpartum care isn’t just about taking time off work. It’s about your physical and mental recovery, and most employers think offering parental leave is enough. But leave isn’t the same as actual postpartum care.
Many parents don’t realize that unless they coordinate with HR and dig deep into their health plan before delivery, they won’t know what benefits they’re really getting once they’re home with a newborn. The key is transparency. Most employers want to help but aren’t always well versed in their plan offerings which affects individual employees, so it’s important for parents to be proactive and have these conversations ahead of time, you could be left scrambling when you need support the most. Don’t be afraid to ask the right questions in advance so you can make sure your postpartum care is actually covered.
Types of health insurance plans
Let’s break down the key types of plans in a way that makes it easier to spot which health insurance may work best for your family. For more details about your specific insurance plan, be sure to speak with your employer to help put you in to with someone who can adequately explain your benefits.
- HMO (Health Maintenance Organization)
With an HMO, you choose a primary care doctor, and they direct your care, referring you to specialists when needed. It’s usually the most affordable in terms of premiums and out-of-pocket costs. But, if you go out of network, you’ll likely have to pay full price. - PPO (Preferred Provider Organization)
If you want flexibility and options, a PPO gives you a little more breathing room. You can see specialists without referrals and aren’t limited to a network (though staying in-network will save you money). This type of plan has higher premiums but is great for families who need to visit specialists or want the freedom to see the doctors they choose. - EPO (Exclusive Provider Organization)
An EPO is kind of the middle ground between an HMO and PPO. While referrals aren’t needed, you’re encouraged to stay within your network of doctors. Going out of network means paying entirely out of pocket. - POS (Point of Service Plan)
A POS plan is kind of a hybrid between an HMO and a PPO. Like an HMO, you need a primary care doctor for referrals but like a PPO, you can go out of network for a higher cost.
If you’re juggling specialists or want options, a PPO or EPO might be your best bet. If your main concern is cutting costs and you don’t mind the structure, an HMO could be a great fit.
Important health benefits for parents and families
- Maternity care
From prenatal visits to the delivery room, your plan needs to cover the essentials of pregnancy and childbirth. This is non-negotiable. Look for a plan that offers comprehensive maternity care, including routine checkups, ultrasounds, birthing classes, labor and delivery costs, lactation consultations, and prenatal and postpartum visits. World Health Organization (WHO) postpartum care guidelines recommend at least four postpartum visits in the first six weeks postpartum to ensure birthing parents are being closely monitored. - Newborn and pediatric care
Once your baby is out in the world, they’ll need their own doctor — and probably have a lot of appointments. Your plan should include coverage for newborn screenings, well-baby checkups, immunizations, and any specialist visits your child may need. - Breastfeeding support
Breastfeeding can be a beautiful, bonding experience, especially if you’ve got the right support. Thankfully, under the Affordable Care Act (ACA), health insurance plans are required to cover breastfeeding support and supplies. But not all plans are created equally. Ideally, coverage includes breast pumps (yes, plural!), lactation consultations, and follow-up support for when you run into common breastfeeding challenges. - Mental health coverage
Your mental health matters. It’s important to have insurance that covers therapy and mental health services in the event you want help managing postpartum anxiety, navigating the stress of raising kids, or just need someone to talk to without judgment. - Preventive care
Preventive care benefits include annual physicals, immunizations, screenings, and flu shots. For expectant parents, make sure your plan covers routine prenatal screenings, gestational diabetes, and necessary tests, and vaccines during pregnancy. For kids, coverage for regular checkups and vaccinations are a must. - Prescription drug coverage
Whether it’s antibiotics for your little one’s ear infection or ongoing prescriptions for chronic conditions, it’s important to have insurance that covers prescription drugs. Also, find out if the plan covers name-brand vs. generic options and how much you’ll need to pay out-of-pocket. - Telehealth services
Getting to the doctor’s office isn’t always easy — especially with a newborn. Many plans now cover telehealth services, making it easy to hop on a video call with your doctor or pediatrician without leaving the house.
How to advocate for the benefits you need
What should you do if your employer’s health insurance plan doesn’t meet your needs? You have options, and it’s crucial to know your rights and take action. You don’t have to settle!
- Explore marketplace plans: The Affordable Care Act (ACA) marketplace may offer better options with more comprehensive coverage for your growing family. Look for plans that cover pediatric care, maternity benefits, and other essential services your employer’s plan may lack.
- Ask about supplemental insurance: Find out if your employer offers additional insurance options like specialized maternity coverage that can fill in the gaps of a basic health plan.
- Negotiate with your employer: Employers sometimes have flexibility with their insurance offerings but won’t make changes unless they know there’s demand. Advocate for yourself and your family by requesting better maternity, pediatric, or mental health coverage.
Remember, you’re your own best advocate. If your employer’s health plan falls short, take control, and explore every possible avenue to ensure your family is fully covered. We know this process can be complex and we know this process can be complex and confusing. And that’s why we’re here every step of the way, to help you navigate it. Contact us to learn more about insurance covered lactation care and schedule a consult with an International Board Certified Lactation Consultant. An IBCLC can teach you individualized strategies to enable you to have a confident and empowered breastfeeding experience as a parent in the workforce.
We’re here for you, every step of the way. We work with your insurance to provide in-home, in-office, or telehealth visits with an IBCLC.
