Individual and Family
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.
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.
You can expect coverage for services you need throughout pregnancy, inpatient services, and newborn care.
Some covered services often include:
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.
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.
If you are pregnant and uninsured, you have a few options to find coverage or low-cost maternity care in your area.