Whether a surrogate's pregnancy is actually covered comes down to the specific policy she carries today, not to anything in state law. This page is the checklist — the state-by-state pages link here instead of repeating it 51 times.
Start with the current policy, in writing
Don't rely on a phone call with a customer-service rep. Ask the carrier (or have the agency's case manager ask, in writing) for a written determination of whether the plan excludes a surrogate or gestational-carrier pregnancy. Many individual and small-group plans carry an explicit surrogacy exclusion; employer plans vary widely. Get the answer in writing before the , not after.
Know the difference between "no maternity coverage" and "surrogacy exclusion"
A plan can cover maternity care generally and still specifically exclude a pregnancy where the surrogate is being or is carrying a child she doesn't intend to raise. Read the exclusions section of the policy itself, not just the maternity benefits summary.
ACA marketplace plans
Marketplace plans must cover maternity care as an essential health benefit, but that requirement doesn't override a plan's surrogacy exclusion where one exists, and marketplace plans purchased specifically to cover a planned surrogacy pregnancy can run into insurer pushback or non-renewal. If the surrogate doesn't already have a marketplace plan in place well before matching, treat this as a real risk to plan around, not a fallback.
If the existing plan excludes surrogacy
A dedicated surrogacy insurance policy (sold specifically to cover a gestational carrier's pregnancy and delivery) is the standard fallback, and its cost is typically built into the account funded by the intended parents, not paid out of pocket by the surrogate. Confirm who is financially responsible for the policy premium, the deductible, and any complications coverage before signing the — this should be spelled out in the contract, not left informal.
Life insurance
Many agencies and intended parents arrange a term life insurance policy on the surrogate for the duration of the pregnancy and a short period after delivery. If this is part of the arrangement, confirm who pays the premium and who the beneficiary is, in writing, before the transfer.
Medicaid
If the surrogate is on Medicaid, don't assume it will cover the pregnancy. Medicaid eligibility is need-based, and using it for a compensated surrogacy arrangement raises both coverage and third-party-liability questions that vary by state Medicaid agency. Most agencies advise against relying on Medicaid for a surrogate's pregnancy care — plan for a commercial or dedicated surrogacy policy instead, and raise this directly with the agency or attorney handling the arrangement.
This isn't insurance or legal advice
Every policy is different, and small details in the plan document can change the answer. Confirm directly with the carrier and with the professionals handling the arrangement before relying on anything here.