Pregnant women who needed health insurance to cover their maternity costs were faced with few choices in 2013 and the years prior. They might search the plans from top to bottom and find none to buy that provided coverage for maternity-related services. However, the Affordable Care Act has dramatically increased the options available for pregnant woman.
You can find price quotes for maternity insurance on this site.
Maternity insurance didn’t start with the “Obama Care” law. Prior to the effective dates of the mandates, many if not most, group health insurance policies covered the costs of childbirth. Some non job-related plans covering individuals and families also covered these medical expenses as did Medicaid and Medicare.
However, a woman who was not insured when she conceived would be denied for most plans. She would have been considered to have had a preexisting condition since her pregnancy started before the effective date of her policy.
Things have changed. Pre existing conditions including pregnancies cannot be used as a reason for a company to deny coverage for policies with that are effective on or after January 1, 2014. Nor can a person’s medical history be used to increase the cost of their coverage. This means that the carrier is required to offer the cancer patient the same options, at the same premiums as the person who runs marathons and has a pristine medical record. (Providing they both live in the same area and are the same age.)
Before 2014, many could not afford health insurance with maternity coverage. In areas where this coverage was available at all it was generally an optional benefit. Families that didn’t want children could save money by choosing not to have this coverage. Today the cost of maternity coverage is borne by men and women whether they plan to conceive or not. This may seem unfair, and perhaps it is, but it raises the cost of everyone’s coverage by a very small amount instead of raising the cost of a few people’s coverage by a lot.
(Although it is true that all contracts have to say that they will cover maternity costs, It is not true that a 65 year old woman pays for it. However, a 30 year old man will pay for it. When all is said and done, the insurers add up the cost of providing medical care for all the people they insure in your age group who have a particular policy – regardless of gender – and divides that cost evenly amongst them. If no one in your age group gets pregnant, you never pay a portion of someone else’s pregnancy even if your contract says that it covers maternity costs.)
For some, the best health insurance for pregnancy was Medicaid. Other women who didn’t meet the eligibility requirements for the Medicaid program may not have been eligible for coverage at any cost.
Neither the pregnant woman, the athlete nor the cancer patient will be able to purchase private individual health insurance outside of the open enrollment period unless they qualify for an exception. (They may be able to sign up for government-sponsored plans like Medicaid or employer-sponsored plans at other times of the year.) The next Open Enrollment period will start on November 15th of 2014 and will end on Valentine’s day of 2015. After that, open enrollment periods will start on October 15th and end on December 7th of each year.
What are the Exceptions to the Open Enrollment rule?
If a person has lost health insurance coverage, due to no fault of their own, they are likely to qualify for an exception. If, for example, they were recently laid off and lost coverage they could apply for a policy outside of the open enrollment period. If they lost coverage due to a failure to pay premiums, they would not be able to purchase a policy.
Exceptions to the Open Enrollment Period include:
- Birth or Adoption of a Child
- Losing other coverage
Insuring the Baby
When you look at the statistics, the first year of life is a dangerous one. A baby with a birth defect who isn’t covered by insurance may not get the care she needs. A medical catastrophe is more likely to happen before a child’s first birthday than any other year during childhood.
For this reason, it is important that, even if you cannot get health insurance for the pregnancy a woman should make sure that she insures her child as soon as she can. Childbirth is an exception to the open enrollment rule.
All plans that the meet the minimum standards of the Affordable Care Act must cover maternity costs subject to the plans deductible, co-pays and other cost shares as well as prevention related expenses such as annual check-ups.
If you would like our help finding affordable health insurance with maternity coverage, please request quotes on this site for ACA qualified policies.