Can I get insured while I’m pregnant? Learn what your coverage options are while with-child under the ACA.
Yes, you can get health insurance while pregnant. In the past pregnancy had been considered a preexisting condition, however under the Affordable Care Act (ACA) health insurance plans must cover pregnancy along with other essential benefits. Additionally, if you are pregnant and uninsured there are likely resources in your state to help you get low-cost maternity care until giving birth triggers a special enrollment period, which will allow you to enroll in health insurance outside of the open enrollment period.
Could you always get health insurance while pregnant?
You can get health insurance while pregnant now. However, that has not always been the case. Since the ACA was signed into law, pregnancy and newborn care is an essential benefit that all qualified Marketplace plans must provide.
Prior to the ACA, only around 12% of individual plans on the market had pregnancy as a covered expense, according to the National Women’s Law Center. Only 9 states required maternity benefits at the time.
Maternity coverage was only offered by some plans or had to be added on as a special rider in addition to a plan that often had a waiting period. Pregnancy was considered a pre-existing condition by insurers. This meant that coverage was either unavailable to women who were pregnant at the time of enrolling or would end up costing them more.
Additionally, some insurance carriers would see a previous cesarean section as a reason to decline, or charge a higher premium.
The ACA named maternity care as one of its 10 essential benefits that all marketplace plans must cover.
What coverage can I expect with a marketplace plan?
You can expect coverage for services you need throughout pregnancy, inpatient services, and newborn care.
Some covered services often include:
- Outpatient services – This includes prenatal and postnatal visits to the doctor, gestational diabetes screenings, laboratory services, medications, etc.
- Inpatient services – This includes things like hospitalization and physician fees
- Newborn care
- Lactation counseling and devices
Keep in mind that while maternity is a covered expense, health insurance companies can choose how they cover these benefits. Additionally, your out-of-pocket costs are dependent on factors like the metallic tier of coverage you have, deductibles, and copayments.
When do I enroll in a health insurance plan to cover my pregnancy?
You can enroll in coverage every year during the open enrollment period for coverage starting in the following year. Open enrollment usually starts on November 1st for coverage starting in the next calendar year.
In most states, becoming pregnant is not a qualifying event that allows you to enroll in or change your health insurance plan outside of open enrollment. However, according to healthinsurance.org there are laws in New York and Connecticut that allows pregnancy to trigger a special enrollment period.
Even though in most states pregnancy is not considered a qualifying life event, the birth of your child is. If you are looking for an opportunity to enroll in health insurance or change your plan outside of the open enrollment period, the birth of your child is an opportunity to do so.
What if I am pregnant and uninsured?
If you are pregnant and uninsured, you have a few options to find coverage or low-cost maternity care in your area.
- Public health department: Many local health departments provide maternity care. However, you may have to meet an income criteria.
- Community health center: These centers provide care to those with limited access to health care services. They do not provide maternity or baby insurance, but they do provide comprehensive prenatal care with fees that are usually based on income.
- Medicaid: If you are without health insurance and are a low-income household or individual, you may qualify for Medicaid. Even if you don’t think that you are eligible based on income alone you should still apply as eligibility levels are higher for pregnant woman than they are for other adults. Additionally, you can apply year round.
- CHIP: The Children’s Health Insurance Program provides health insurance to uninsured children. However, in a few states it also provides coverage to pregnant women. Even though CHIP focuses on low-income families, CHIP has a higher income threshold than other government run programs. Like Medicaid, you can apply year round.
- Hill-Burton Facility: There are 136 hospitals and clinics nationwide that are obligated to provide free or low-cost care because they have accepted loans under the Hill-burton act. Request to apply for Hill-Burton free or discounted care at one of these facilities. You do not have to be a US citizen to qualify, but you do need to meet low-income requirements.
- Charity care organizations: There are organizations such as Catholic Charities and Lutheran Services that offer services to help women with pregnancy care. Services may vary depending on your location, however some services are as extensive as free maternity care, postpartum care, and lodging.
- Planned Parenthood: Some, but not all, Planned Parenthood locations provide pregnancy care. Some locations base their prices on a sliding-scale based on your income.
- Self-pay rate: If you end up having to pay for your pre and postnatal care out-of-pocket, you may be able to negotiate a self-pay rate. Frequently, hospitals have a self-pay discount rate or a charity rate. Asking what the charity rate is may help you know how to qualify and help start negotiations.