Understanding who is covered under which health insurance policy can seem daunting when you’re first learning about the adoption process, but it’s usually simpler than it seems. While every situation is going to be unique, and your health insurance policy and procedures may vary, the following guide will help you understand a bit about how health insurance works in adoptions, whether you’re pregnant and choosing adoption, or you’re adopting a child and adding her/him to your insurance policy.
For specific questions or concerns, contact your health care provider or your insurance provider, or contact your adoption specialist at 1-800-ADOPTION.
For Pregnant Women Choosing Adoption
Finances can be a contributing factor when deciding what to do about an unplanned pregnancy. If you’re pregnant and concerned because you’re uninsured, don’t panic. Most adoption professionals, including American Adoptions, will cover the medical costs associated with your pregnancy and childbirth.
Understanding whose insurance will pay for what can be a little confusing, too. But here’s how it typically works:
- If you have health insurance, then we can help you find health providers within your plan, and the agency/adoptive family may be able to assist with any deductibles or copays.
- If you don’t have health insurance, we can help set you up with Medicaid or a similar state-funded program, if possible.
Whatever out-of-pocket costs aren’t covered by health insurance, the agency/adoptive family can usually find a way to help decrease those costs if not cover them completely. The important thing is that you and your baby receive the health care that you need.
American Adoptions also covers the costs of legal and emotional counseling, as well as living expenses for eligible birth parents who need assistance.
For Adoptive Parents Adding a Child to Their Policy
Another common point of confusion comes from adoptive parents who aren’t sure how to add a child to their current health insurance plan. Here’s how that will work:
- Adoptive parents are responsible for the child’s medical bills incurred from the time of birth until the child is discharged from the hospital.
- Your health insurance provider is required by law to cover adopted children the same way they would biological children.
- Once your child’s birth parent(s) have officially consented to the adoption in accordance with state laws, you may request the addition of your child to your health insurance plan with your provider. The Health Insurance Portability And Accountability Act of 1996 (“HIPAA”) prevents insurance providers from denying an adopted child coverage based on any preexisting condition if the adoptive parents request enrollment within 30 days of placement, so be sure to enroll your child within that 30-day timeframe after placement occurs.
Adoptive parents aren’t legally responsible for a birth mother’s medical costs; just the baby’s. Birth moms are usually on a separate insurance plan, as outlined above.
The goal is to ensure that all expectant mothers and children being placed for adoption are able to receive the health care that they need, regardless of cost. So if you have questions about adoption and health insurance, please call your doctor or your insurance provider, or contact your adoption specialist at 1-800-ADOPTION.
Can you please help clarify- the comment that adoptive families are responsible for the child’s costs from birth to discharge. What happens with scenarios where the child is born, the birth mom is given 72 hours to sign over the baby and then changes her mind. Whom covers the expenses then?
Heather, in that case, the birth family would be responsible for medical expenses. Typically, an adoptive family would not add the child to their insurance until this 72 hour period is over, at which point it would be back dated to cover the child’s birth and hospital stay. Please feel free to contact our office at 1-800-ADOPTION if you have any further questions!
What if the mother is currently receiving medicaid. Will Medicaid cove charges from birth until child is discharged? Or will the hospital place those charges on the adoptive parents?
In most cases, the adoptive parents will be responsible for the baby’s medical costs, as mentioned in this article. But, every insurance policy is different, so we encourage you speak with your adoption professional or your hospital representative for more guidance on this situation.
If a child was legally adopted at the age of 10 years old, is there a law with in Federal and/or State, to have the child covered under a certain health insurance until child is of adult age. Not a parent’s private insurance and not State Medical assistance through the Department of Economic Security.
Hi, there — American Adoptions only deals with infant adoptions, so we cannot provide guidance on this subject. We encourage you to reach out to a local foster care adoption agency or adoption attorney for information on this topic. Good luck!
i adopted my son at 10 years old.he is now 17.with state insurance.what age does he come off state insurance.so i can put him on our insurance through work.
Hi, Judy — Every state’s policies for Medicaid coverage is different. We’d encourage you to reach out to your foster care provider for more information on this topic. In the meantime, here’s an article that may help: https://www.childwelfare.gov/pubPDFs/health_care_foster.pdf
I was wondering what if the birth mother can not get insurance through dhs because she makes to much but can’t afford work insurance and wants to do private adoption to a friend what options does she have? She is 19 weeks and hasn’t been to the dr yet because she’s not covered what can I do as the adopting friend?
Hi, Tiffanie — Have you reached out to a local adoption attorney? You’ll need one to complete this process, even if you are adopting from a friend, and they may be able to provide some guidance on health care insurance for the prospective birth mother. You should be prepared to pay for the prospective birth mother’s medical expenses, as per your state’s laws on living expenses.
You can start your search for a licensed adoption attorney here: https://adoptionart.org/find-an-attorney/
My employer said that they will only cover the child after the adoption has been finalized even though we have custody. Is this legal in Ohio?
Hi, Evan — We are not legal experts, so we cannot answer this question. Please reach out to a local attorney for guidance in this situation.
Did you ever figure this out? I have a similar situation happening in PA…
I don’t have insurance through work ((I’m Canadian, and our medical care is paid through taxes)). I am travelling to Florida to adopt a baby there. Bio Mom has applied for and qualified for Medicaid.
If I don’t have work insurance, and thus have no plan to “add” baby to, do you know of any private health insurance providers who have policies for adopted babies in this type of circumstance? If I can’t find a private provider, baby will be insurance-less.
Hi, Lee — We cannot offer specific advice for your situation (we only complete private domestic infant adoptions), but you might reach out to your adoption agency or the Florida Medicaid office for more information. Good luck!
I am adopting a child, and the adoption is in process. Our insurance company is insisting on a “legal document” that states the adoption has been processed before they’ll add her. If they are required to cover her, can they insist on this? Of course the adoption is being delayed because of the pandemic. Advice on what I can provide them until I have a finalized adoption order?
Hi, Beth — Because insurance requirements vary by provider, we can’t give you personal advice. We advise you speak with your adoption attorney or agency for guidance. Good luck!
Insurance is requiring document stating who is legal guardian. By birth, parents are natural legal guardians. Whoever, in your circumstance, a court document stating that whoever is the newly appointed legal guardian aka adoption parent/s proves to insurance that they have legal standing to cover the adoptee.