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.
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.
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.
Think carefully about dropping any health insurance policy you may have even if it will not cover your pregnancy. There are several reasons for this.
Even if your costs for childbirth aren’t covered your child can be. In most cases if a parent has a valid health insurance policy (even if it doesn’t include maternity insurance), the company will automatically accept their baby so long as the parent so requests before the child is 30 days old. This can be huge! If your child has need for neonatal care the costs can be hundreds of thousands of dollars.
Even a policy that does not cover normal maternity expenses is likely to cover the cost of complications of pregnancy. The complications are considered an illness. For this reason, you are likely to have them covered.
Since you can get sick or hurt while you are pregnant, you should maintain your health insurance even though it may not cover any of your maternity expenses.
You can get sick in such a way that you will not qualify for health insurance even after your child is born. Some women develop medical conditions during their pregnancy that stay with them for long periods of time.
Insurance applicants are denied because of preexisting conditions all the time. If you develop a condition while uninsured, you may not be able to get coverage again.
If apply for other health insurance coverage whether pregnant or not, you should take care not to cancel your existing policy until you have received notice that the new policy has been approved.
Suggestions from your OB/GYN and Planned Parenthood
If none of the above will work for you there are two more strategies that you can try. You can make an arrangement to prepay your hospital bill by contacting your hospital directly. You can sign up for a maternity discount plan.
You may want to shop around to see if the hospitals near you charge differently. They may have different fees for medical services and different arrangements for prepaying your bill.
If you chose to find a discount plan, be aware that you are not purchasing insurance. You will merely be getting a discount on your medical expenses.
Health insurance coverage that includes maternity insurance is often not available to women who are already pregnant. However, there are some situations where an already pregnant woman can find coverage.
There are certain situations where a person cannot be denied health insurance. In many areas, group insurance is a guaranteed issue product. This may mean that even if you are pregnant a group medical and maternity insurance policy will be available to you.
Group health insurance policies are not only available to large corporations. They are also available to very small employers as well.
If you are self-employed, you may find that you will qualify for a group insurance policy. In many areas a “group” can consist of one person.
This can mean that if you or your spouse is self-employed, you will be eligible for group health insurance coverage. You can be insured as the primary insured or as the dependent.
Finding maternity insurance when you are already pregnant can be difficult. Insurance companies that cover maternity will often deny coverage to women who are pregnant when they apply.
Coverage may not be available to you in the private market. This is unfortunate because the best policies for health and maternity coverage are generally found from private insurers.
If you are able to find coverage through a group health insurance policy, you may be able to get private health insurance. This can dramatically lower the amount of money you will have to pay for the birth of your child.
If your employer will have an open enrollment period before your due date, you may be able to sign up and get coverage. For most women, the vast majority of the medical care needed for their pregnancy will be needed in the hospital when they give birth. This means that getting coverage before your due date will entitle you to having most of your bills covered.
If your domestic partner or spouse has an open enrollment at their job before your due date, you may be able to be added to his or her policy. This can also save you a lot of money.
If you cannot wait until the next open enrollment period, there is one more strategy that may be available to you. If you marry someone who has group insurance, you will probably trigger a special open enrollment period. You may be able to get coverage right after your marriage even if the regular open enrollment period is months away.
Be sure to make sure that any policy you apply for includes maternity coverage.
Be aware of any waiting period before you are fully covered.
Make sure you fully understand any policy you apply for.
Do not drop any existing coverage before you have an official approval notice from the new company.
Always make sure that any advice you get regarding health insurance is applicable to your city and state. Many health insurance regulations are state-specific.
If you are already pregnant and the strategies above will not help you, consider calling your local planned parenthood office. They may be able to tell you about programs available from your local government. There may be other resources that are specific to your area that they can tell you about.
Maternity insurance may be available to you from one of several places. Failing to investigate your options may result in your paying thousands of dollars out of your pocket for medical bills. The cost of delivering a child is very high today. You can easily rack up bills that are over $15,000.
You may be eligible for maternity coverage through your employer or your spouse’s employer, you may be eligible for a government-sponsored program and you may be eligible for a non insurance discount plan.
The first place to investigate is the group insurance options you may have. Group insurance policies are often available without medical questions.
Group insurance may be available from one of several places. You may have options with your employer. Your spouse may be able to add you to his or her coverage. If you are self employed you may be able to purchase a group plan.
If your employer offers group insurance, you may be able to get coverage during the next open enrollment period providing that the next open enrollment period is before your due date.
Be sure to look at options with your spouse’s employer as well. You may find that you are eligible to be placed on his or her policy. If you are not yet married, but plan to be before your baby is born, you may be able to request a special open enrollment period and not have to wait as long.
If you are self-employed, there may be policies that you cannot be denied for available to you as well. In many states, a company with one employee qualifies for group insurance. These plans will often have no medical underwriting so you may qualify even if you are already pregnant.
There may be government-sponsored programs that are available to you. You should check your options with federal, state, county and municipal programs. Many of these programs will cover women who are currently pregnant and dramatically reduce the out-of-pocket costs.
If you have exhausted the above options, you may want to investigate non-insurance policies that will help you get a lower rate from your local hospital. These plans allow you to get a discount on the hospital bill. You will still wind up paying a significant amount of money but you will be paying a lower rate.
You will have more and probably better options if you purchase health insurance that covers maternity before you get pregnant. Individual maternity insurance may offer you the best deal, but these plans are typically not available to women who are pregnant when they apply.
If you are currently pregnant, be sure to investigate all your options before giving up and being stuck with a big bill. Employer-sponsored health insurance may be available from your employer, your spouse’s employer, your future spouse’s employer, or from your business if you are self employed. You may also find that government-based programs are available to you through a local, county, state or federal government program. If you are not eligible for any of the above a non-insurance policy designed to lower your health insurance bill may be the best option for you.
Having a baby without insurance can be costly. You may have some options that can lower those costs. You may be able to get insurance before your due date although it is always better to get insurance before you conceive. A normal delivery can cost $10,000 or $20,000 or even more. Of course the cost of complications can make the cost much higher.
If you are currently pregnant and have no insurance and you are eligible for a group insurance policy you should look into that option first. Also there may be state-sponsored programs available to you that will cover part of the cost of your pregnancy. These options differ in each state. Try contacting your state’s insurance department or your state’s department of public health to get a number to call.
If all else fails, shop around and find out which local hospital offers the lowest cost for maternity care. You should also see if they will give you a discount if you can prepay your bill. You may be surprised at how much the price drops.
If you have health insurance, even if it does not cover normal child birth, it probably covers the complications of child birth. If this is the case, it is important to keep your current medical insurance in place if better options are not available to you.
Having insurance for your newborn is also important. If you have insurance for yourself whether or not it includes covers maternity insurance you can probably add your newborn to your health insurance policy even if he or she has medical issues. However, you will need to inform the insurance company right away of your intention to add your child. You will typically have 30 days from your baby’s birth to do this.
Because of the high cost, having a baby with no insurance can really impact your ability to enjoy motherhood and fatherhood.
If you are planning to have a child, but have yet to conceive, maternity insurance may be available to you. In many areas these plans can be purchased directly from an insurance company. In other states maternity insurance is only available through employer-sponsored insurance policies.
When purchasing a health insurance policy that covers maternity, it is important to be aware that some will not cover your pregnancy unless your policy goes into effect before you get pregnant. Some require that you conceive long after the effective date. Be sure to check this provision before you try to get pregnant.
Do what you can to avoid having a baby with no insurance. The cost of childbirth is high as is the potential cost of having a child with medical problems. Private and government-sponsored programs may be available to you to lower your costs.