North America Maternity Health Insurance Market Outlook, 2029

Maternity health insurance in North America has progressed notably over the last hundred years, with policies influenced by social, political, and economic elements. Traditionally, maternity care was not extensively included in insurance plans. In the early 20th century, health insurance mainly concentrated on hospitalization and surgical procedures, leaving maternity care to be financed out of pocket. Women needed to depend on personal savings or charitable assistance for prenatal care and childbirth. The significant change in maternity coverage occurred in the 1930s began to regard health insurance for wider requirements.

However, maternity care was predominantly omitted from the initial policies of the 1940s and 1950s, as numerous insurance companies perceived it as a pre-existing condition or a regular, non-medical occurrence. It wasn’t until the 1970s that initiatives to incorporate maternity care into insurance plans gained momentum, partly fueled by the feminist movement, which advocated for improved healthcare access for women .In 1973, the Health Maintenance Organization (HMO) Act established guidelines for health insurance, resulting in increased inclusion of maternity care in employer-provided health plans. The Affordable Care Act (ACA) in 2010 represented a pivotal moment for maternity coverage.

It mandated that maternity and newborn care be regarded as essential health benefits, necessitating that private insurers cover these services, including prenatal care, labor and delivery, and postpartum care, without imposing lifetime or annual limits. Maternity coverage has been incorporated into the public healthcare system since the 1960s, as provincial insurance plans started to cover the expenses of pregnancy-related services and childbirth. This universal coverage has afforded many women access to prenatal and delivery services without direct financial strain. Currently, maternity health insurance in North America guarantees comprehensive care, although challenges such as coverage gaps and inequalities in access persist, particularly in underrepresented communities.

According to the research report, ' North America maternity health insurance Market Outlook, 2029,' published by Bonafide Research, the North America maternity health insurance market is anticipated to add to more than USD 18.84 Billion by 2024-29. Maternity health insurance in North America has expanded considerably due to various elements, including social transformations, healthcare reforms, and regulatory changes. Primary growth factors include the women’s rights movement, which championed equitable access to healthcare, and a growing awareness of the significance of maternal health.

The Affordable Care Act (ACA) of 2010 marked a significant development, mandating private insurers to provide maternity care as an essential benefit, ensuring that prenatal, delivery, and postpartum care were provided without cost-sharing or lifetime caps. This policy was vital in broadening access to care for millions of women. The COVID-19 pandemic had a significant effect on maternity health insurance. At first, there were worries about disruptions in healthcare, but the pandemic sped up telehealth services, which assisted pregnant women in accessing prenatal care safely from home.

Nevertheless, the economic difficulties caused by the pandemic resulted in job losses, affecting employer-sponsored insurance coverage for numerous women, especially in sectors with greater layoffs. Furthermore, the pandemic underscored healthcare disparities, with marginalized communities encountering more substantial obstacles to obtaining maternity care. While the ACA requires maternity coverage in private plans, there remain gaps in Medicaid, which only provides maternity services in specific states for low-income women. Certain states have broadened Medicaid to offer comprehensive maternity care, while others have restricted coverage, leading to inequalities in access.

However, private insurance alternatives complement public coverage, offering benefits like extended maternity leave or extra services such as home birth support. In addition, maternity health insurance in North America has progressed from limited access to more extensive coverage, fueled by regulatory advancements, societal changes, and the necessity for improved maternal health outcomes.

Market Drivers

• Legislation such as the Affordable Care Act (ACA) in the United States, which mandates maternity coverage as a fundamental benefit, has greatly enhanced access to healthcare services. These regulations obligate insurers to provide coverage for prenatal, delivery, and postpartum care without imposing cost-sharing requirements.
• There is a rising recognition of the significance of maternal health and the necessity for comprehensive care, which has led to a heightened demand for maternity insurance. This shift has resulted in better access to both prenatal and postnatal services.
• Companies are increasingly acknowledging the value of providing maternity coverage as a means to attract and retain talent, particularly in light of the growing trend towards family-oriented workplace policies .
• The COVID-19 pandemic has expedited the integration of telehealth services for prenatal and postpartum care, facilitating easier access to healthcare for women remotely.

Market Challenges

• Although the Affordable Care Act requires maternity care to be included in private insurance plans, significant disparities persist, particularly within Medicaid, where coverage is inconsistent across states. Certain states provide limited benefits, resulting in low-income women lacking full access to vital services.
• Elevated out-of-pocket expenses for women, particularly those enrolled in high-deductible health plans, can restrict access to maternity care. Many families experience financial pressure due to expenses related to prenatal testing, childbirth, or postnatal care that are not covered.
• Communities, including racial and ethnic minorities, frequently encounter disparities in maternal healthcare, resulting in suboptimal outcomes. These populations are less likely to possess comprehensive insurance and often face challenges such as insufficient access to healthcare facilities.
• A significant portion of maternity benefits is linked to employment, which can be precarious due to job loss or transitions, leaving expectant mothers without adequate coverage.

Market Trends

• The COVID-19 pandemic has expedited the adoption of telehealth services for both prenatal and postnatal care, enabling women to receive consultations from the comfort of their homes. This trend is on the rise, particularly for routine examinations and mental health services.
• A growing number of insurance providers are enhancing their maternity care offerings to include comprehensive services such as prenatal appointments, labor and delivery, and postpartum care. This shift is largely influenced by consumer preferences and the necessity to stay competitive in a market that increasingly prioritizes family-oriented benefits.
• There is an increasing acknowledgment of the mental health challenges faced by new mothers. Insurance plans are evolving to incorporate coverage for postpartum depression, therapy, and counseling, thereby addressing both physical and emotional health needs.
• Employers are progressively providing more substantial maternity benefits, which include paid leave, flexible working hours, and insurance plans with improved coverage, all aimed at attracting and retaining skilled employees.

The segment of delivery coverage is experiencing significant growth within North America's maternity health insurance market, driven by the critical and often expensive nature of childbirth, heightened awareness of maternal health issues, and regulatory requirements.

Childbirth entails considerable medical expenses, encompassing labor, delivery, and the possibility of specialized care. Consequently, delivery coverage has emerged as a vital aspect of maternity health insurance. The escalating costs associated with hospital stays, surgical procedures (such as cesarean sections), and newborn care have made comprehensive delivery coverage a priority for both insurers and policyholders. The financial implications of childbirth without insurance can be daunting, underscoring the necessity for insurance providers to deliver substantial delivery coverage to ensure that both mothers and infants receive essential care without incurring financial hardship.

Moreover, the growing recognition of the significance of maternal health has spurred an increased demand for extensive maternity services, including delivery coverage. A rising number of women are pursuing insurance plans that provide enhanced protection during childbirth, acknowledging the potential for unexpected complications that can elevate overall care costs.

This shift in consumer preferences has prompted insurers to broaden their delivery-related service offerings, contributing to its rapid expansion in the market. Additionally, regulatory developments, such as the Affordable Care Act (ACA) in the United States, have mandated that maternity care, including delivery, be included in all private health insurance plans.

This legal stipulation has further propelled the growth of delivery coverage by compelling insurers to incorporate comprehensive care into their offerings, thereby enhancing accessibility for a wider demographic. In addition, the rapid expansion of delivery coverage in North America's maternity health insurance market can be attributed to its fundamental role in maternal healthcare, the increasing consumer demand for more comprehensive insurance plans, and regulatory mandates that promote improved access.

Public insurance providers hold a predominant position in the maternity health insurance sector in North America, largely due to the extensive availability of government-funded initiatives.
Medicaid serves as a crucial resource, offering comprehensive maternity care to women with low incomes. It accounts for nearly half of all births in the country, thereby ensuring that women from lower-income backgrounds receive necessary prenatal, delivery, and postpartum care. Although Medicaid is funded at the state level and eligibility criteria differ among states, it remains an essential support mechanism for those who are uninsured or underinsured during pregnancy. Given the prohibitive costs associated with private insurance, Medicaid's broad coverage is vital for millions of women seeking maternity health insurance. The public healthcare system is integral to maternity care.

Since the introduction of universal healthcare in the 1960s, women have been able to access critical maternity services without incurring direct costs at the time of service. This encompasses prenatal appointments, childbirth, and postnatal care, all of which are fully funded by provincial health plans. Consequently, a significant majority of women depend on public insurance for their maternity needs, reinforcing its leading role in the market.

Moreover, public insurance systems have played a pivotal role in promoting equity in maternal healthcare by ensuring that all women, irrespective of their financial status, can access essential services. By eliminating financial obstacles, these systems contribute to diminishing disparities in maternity care, particularly among underserved communities. This broad accessibility and commitment to inclusivity solidify public insurance as the largest segment within North America's maternity health insurance landscape.

In North America, agents and brokers serve as the primary distribution channels for maternity health insurance, leveraging their expertise to guide consumers through the intricate landscape of insurance options.
Their role as intermediaries between insurers and clients is vital, as they assist individuals in identifying the most suitable coverage tailored to their specific requirements. The maternity health insurance sector is characterized by its complexity, encompassing diverse plan structures, regulatory frameworks, and a range of benefits that can be daunting for many consumers.

Agents and brokers provide invaluable support by delivering expert insights, facilitating comparisons among various insurance policies, and ensuring that clients are well-informed about their choices, including aspects such as maternity care coverage in private plans, eligibility for public insurance, and the details surrounding delivery, prenatal, and postnatal services.

These professionals are especially significant within the private health insurance domain, where consumers frequently seek customized policies that align with their unique maternity care needs. By leveraging their market knowledge and fostering relationships with insurers, agents and brokers can assist clients in identifying plans that offer comprehensive coverage while considering budgetary constraints and provider networks. Furthermore, they streamline the often-convoluted enrollment process, enhancing accessibility for individuals seeking maternity coverage. Additionally, agents and brokers play a crucial role in the employer-sponsored insurance sector.

Numerous companies depend on these experts to help formulate benefits packages that include maternity coverage for their workforce. Consequently, agents and brokers are essential in facilitating access to maternity health insurance for a substantial segment of the population, particularly among working individuals and families. Through their capacity to provide personalized assistance, navigate complex insurance environments, and support both individuals and employers, agents and brokers are indispensable in the maternity health insurance market.

The United States of America is experiencing the most rapid expansion in North America's maternity health insurance sector, primarily due to the enhancement of insurance coverage resulting from regulatory reforms, a rising demand for comprehensive maternity services, and the evolution of healthcare policies.

This growth can be largely attributed to significant legislative measures, particularly the Affordable Care Act (ACA) enacted in 2010, which mandated that private insurance providers include maternity care as a fundamental health benefit. This requirement has markedly increased the accessibility of comprehensive maternity coverage for women, encompassing prenatal care, childbirth, and postpartum services. The ACA also eliminated the pre-existing condition clause related to pregnancy, ensuring that women cannot be denied coverage or face higher premiums for maternity care.

Furthermore, there is a growing awareness of maternal health issues and a concerted effort to enhance health outcomes, which has intensified the demand for improved insurance options. Consumers are increasingly seeking comprehensive maternity health plans that cover a wide range of childbirth-related expenses, such as hospital stays, cesarean sections, and neonatal care. This heightened demand has prompted insurers to develop more tailored and competitive plans that address the unique needs of expectant mothers.

In addition, the expansion of public programs like Medicaid in various states has provided coverage for low-income women, further propelling the growth of the maternity health insurance market. Medicaid plays a crucial role in covering a substantial number of births in the United States of America ensuring that pregnant women from underserved communities can access vital care without facing financial obstacles.

Considered in this report

• Historic Year: 2018
• Base year: 2023
• Estimated year: 2024
• Forecast year: 2029

Aspects covered in this report

• Maternity Health Insurance Market with its value and forecast along with its segments
• Region & country wise Maternity Health Insurance market analysis
• Application wise Maternity Health Insurance distribution
• Various drivers and challenges
• On-going trends and developments
• Top profiled companies
• Strategic recommendation

By Coverage Type

• Pre-natal Coverage
• Delivery Coverage
• Post-natal Coverage
• Comprehensive Plans

By Service Provider

• Public Insurance Providers
• Private Insurance Providers
• Micro-Insurance Providers

By Distribution Channel

• Agents/Brokers
• Direct Sales& Online
• Bank
• Others

The approach of the report:

This report consists of a combined approach of primary as well as secondary research. Initially, secondary research was used to get an understanding of the market and listing out the companies that are present in the market. The secondary research consists of third-party sources such as press releases, annual report of companies, analyzing the government generated reports and databases.

After gathering the data from secondary sources primary research was conducted by making telephonic interviews with the leading players about how the market is functioning and then conducted trade calls with dealers and distributors of the market. Post this we have started doing primary calls to consumers by equally segmenting consumers in regional aspects, tier aspects, age group, and gender. Once we have primary data with us we have started verifying the details obtained from secondary sources.

Intended audience

This report can be useful to industry consultants, manufacturers, suppliers, associations & organizations related to agriculture industry, government bodies and other stakeholders to align their market-centric strategies. In addition to marketing & presentations, it will also increase competitive knowledge about the industry.


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