Health Insurance for Surrogates: How to choose the right policy

Choosing a health insurance policy as a gestational surrogate can protect your health, your finances, and your relationship with the intended parents.

1. Understand Your Role and Who Pays

Before comparing plans, be clear about who is responsible for which medical costs.

Intended parents are usually responsible for all medical costs related to the surrogacy journey (prenatal care, delivery, and postpartum), even if claims run through your insurance.
Agencies and surrogacy attorneys almost always require that you have adequate health insurance in place before moving forward, even if your state law doesn’t explicitly mandate it.
Your policy covers you and the pregnancy, but the baby’s ongoing medical care after birth must be covered under the intended parents’ policy or a separate policy for the baby.

A strong surrogacy contract should spell out who pays premiums, deductibles, copays, uncovered services, and any out‑of‑network or emergency costs tied to the pregnancy.

Choosing the best surrogate health inusurace policy

2. Look for Surrogacy Exclusions and Clawbacks

The single most important step is confirming whether a plan will actually cover a surrogate pregnancy.

Many employer and individual policies include a “surrogacy exclusion”—a clause denying coverage for any pregnancy where you are acting as a gestational surrogate.
Some plans cover a pregnancy initially but include a clawback clause, allowing the insurer to seek reimbursement if they later learn the pregnancy was a compensated surrogacy.
ACA‑compliant plans must include maternity coverage, but that does not guarantee they will cover surrogacy; you still need a written policy review to confirm.

Always obtain and review the full policy booklet (not just a summary) and have a surrogacy‑savvy insurance professional or attorney check for exclusions and clawbacks in writing before getting pregnant.

3. Know the Main Types of Policies Surrogates Use

Understanding common insurance options helps you and the intended parents choose a sustainable plan.

Existing employer or individual policy: If there is no surrogacy exclusion, your current plan may cover prenatal care, labor, delivery, and postpartum as normal maternity care, with intended parents paying your out‑of‑pocket costs.
ACA marketplace plans (“Obamacare”): These offer standardized essential health benefits, including maternity, and are open to individuals who meet residency requirements, regardless of pre‑existing conditions such as pregnancy.
Surrogate‑specific or “maternity‑only” policies: These are specialized policies designed to cover only the surrogate pregnancy when regular coverage is unavailable or excluded.

If your existing plan cannot be used, intended parents typically coordinate and pay for either a new ACA plan in your name or a surrogate‑specific maternity policy before embryo transfer.

4. Compare Key Cost Features (Not Just Premiums)

A plan that looks cheap monthly can still leave you and the intended parents exposed if costs are structured poorly.

Premiums: Monthly payments for coverage are usually reimbursed or paid directly by the intended parents, but you should understand the amount and timing so you never risk a lapse.
Deductible and out‑of‑pocket maximum: For surrogacy, the size of the annual deductible, coinsurance, and the total out‑of‑pocket maximum (OOP max) matters more than the premium because high‑risk pregnancies and complications can quickly hit those limits.
Copays and coinsurance: Confirm how much you pay for OB visits, ultrasounds, lab work, emergency room visits, and hospital admission, and make sure your contract states that intended parents cover these costs.

Because pregnancy spans months and may cross into a new plan year, discuss how the intended parents will handle two deductibles or OOP maximums if the journey crosses a calendar year or if the plan changes during the pregnancy.

5. Check Provider Networks and Hospital Options

Where you can receive care—and how that affects cost—should be part of your decision.

ACA and many employer plans use networks (HMO, PPO, EPO). In‑network providers and hospitals have negotiated rates and better coverage; out‑of‑network care can bring large surprise bills.
Confirm that your preferred OB/GYN, maternal‑fetal medicine specialist (if needed), hospital, and any fertility‑related providers are in‑network under the plan used for the pregnancy.
Ask what happens in emergencies—such as preterm labor or complications while traveling—so everyone understands how out‑of‑network emergency care will be billed and reimbursed.

You should feel comfortable with the facilities and providers covered by the plan because you are the one undergoing the medical procedures and recovery.

6. Confirm What the Plan Covers During Pregnancy and Postpartum

Your health needs during and after the pregnancy must be fully covered, not only the delivery.

ACA plans must cover essential health benefits, including prenatal care (ultrasounds, labs, screenings), labor and delivery, and postpartum care.
A surrogacy‑suitable policy should cover routine prenatal visits, high‑risk consultations if needed, hospital or birth center fees, anesthesia, C‑sections, and medically necessary postpartum care.
Many policies cover the fetus “in utero” under your policy, but once the baby is born, the baby’s medical bills are the responsibility of the legal parents’ plan.

Also ask about mental health coverage, including counseling or therapy, since emotional support after delivery can be especially important for surrogates.

7. Clarify What Is Not Covered

Knowing the limits of a policy is just as important as knowing its benefits.

IVF and embryo transfer costs are usually not covered by your pregnancy policy; those services are typically billed to the intended parents separately or under a different plan.
Surrogacy‑specific maternity policies often cover only the surrogate pregnancy, not unrelated medical issues or your non‑pregnancy healthcare.
Some policies may limit coverage for certain complications, extended NICU stays (for the baby), or experimental treatments—even if the pregnancy is otherwise covered.

Request written confirmation of coverage decisions whenever something seems unclear, and keep copies in case claims are later questioned or denied.

8. Understand State Law and Legal Requirements

Surrogacy is regulated state‑by‑state, and insurance decisions interact with those laws.

Some states require that a health insurance policy be purchased for the gestational surrogate as part of a legally compliant surrogacy arrangement.
Even where insurance is not legally mandated, intended parents are usually legally responsible for the child’s healthcare costs and must have coverage in place for the baby at birth.
Surrogacy attorneys often use pre‑birth or post‑birth parentage orders to establish legal parentage so the intended parents can add the baby to their insurance immediately.

Working with a surrogacy attorney who understands your state’s laws helps align your insurance choices with legal requirements and avoids gaps in coverage for both you and the baby.

9. Plan for Timing, Enrollment, and Life Changes

Insurance choices are tied to specific enrollment windows and life events, so timing matters.

ACA marketplace plans are generally available during open enrollment (typically November–January), with coverage starting the following year; surrogacy journeys often plan around this.
Special enrollment periods (SEPs) may let you switch or obtain coverage mid‑year after qualifying events such as moving or losing employer coverage.
Surrogacy journeys often span more than a year, so discuss how coverage will be maintained if your job changes, your employer modifies benefits, or you move out of the plan’s service area.

Make sure your contract explains what happens if a policy becomes unavailable or inadequate mid‑pregnancy, and who is responsible for arranging and paying for replacement coverage.

10. Insist on Professional Review and Clear Documentation

Because surrogacy and insurance are complex, you should never feel obligated to interpret a policy alone.

Reputable surrogacy agencies and law firms routinely use insurance brokers who specialize in fertility and surrogacy to review your policy and recommend options.
A formal written policy review can confirm whether your existing plan is usable for surrogacy, whether backup coverage is needed, and how best to structure the journey financially.
Your surrogacy contract should attach or reference the chosen policy, spell out who pays premiums and out‑of‑pocket costs, and describe how disputes over coverage will be handled.

Keeping everything documented—in the legal agreement and in emails—reduces stress and protects you if an insurer questions claims or if unexpected complications arise.

11. Practical Checklist for Potential Surrogates

Before accepting a match or proceeding to embryo transfer, you can use this high‑level checklist:

Confirm there is no surrogacy exclusion or clawback in your plan, in writing.
Verify premiums are funded reliably and that your coverage will remain active throughout the journey.
Understand your deductible, coinsurance, and out‑of‑pocket maximum, and confirm that intended parents will cover these amounts.
Check that your preferred OB, hospital, and any high‑risk providers are in‑network on the chosen plan.
Confirm the baby will be covered under the intended parents’ insurance from birth, with any needed parentage orders handled in advance.
Ensure IVF, embryo transfer, and non‑pregnancy care are planned and funded, even if they are not covered by your pregnancy policy.
Have a surrogacy‑experienced attorney and, ideally, a specialized insurance broker review everything before you become pregnant.

When you choose a health insurance policy with these factors in mind, you protect your physical and financial wellbeing and create a more stable, transparent foundation for the entire surrogacy journey.

Pro Tip: An experienced surrogacy agency will make sure you’re covered by the best-suited insurance policy prior to starting out on a surrogacy journey. Take the 5-minute SurroAdvisor quiz to check your elligilibity and get matched with your dedicated journey coordinator.