Health Insurance Options For Pregnant Women
Women who are expecting can purchase health insurance coverage during their pregnancy, but it depends on the circumstances.
Several ways that expecting mothers can purchase pregnancy insurance are:
- Employer-sponsored health insurance
- Individual policy through a private insurance company
- ACA health insurance marketplace
- Federally-funded programs like Medicaid or Children’s Health Insurance Program
If youre currently uninsured, the only time you can enroll in health insurance while pregnant is during the open enrollment period.
The health insurance marketplace open enrollment is from Nov. 1 to Dec. 15 in most states. Most people get health insurance through their employer. Open enrollment varies by employer, so ask your companys benefits department about the open enrollment dates.
Getting pregnant isnt considered a qualifying life event that starts a special enrollment period. However, having a baby is regarded as a qualifying event that creates a special enrollment period when you can sign up for health insurance.
If you become pregnant and are uninsured, you aren’t allowed to purchase health insurance unless your pregnancy coincides with a qualifying event, such as marriage, moving to a new state, or losing coverage through a job.
I’m Pregnant And Need Health Insurance But I Can’t Get Medicaid
CHIP Perinatal is a similar program for pregnant women who can’t get Medicaid and don’t have health insurance.
CHIP Perinatal includes prenatal visits, prenatal vitamins, labor and delivery and postpartum care.
To find out if you can get CHIP Perinatal, apply for Medicaid and we’ll determine if you qualify.
Can An Uninsured Woman Enroll In Marketplace Coverage Upon Giving Birth
Maybe. If the baby is eligible for Marketplace coverage, then the baby qualifies for an SEP as a new dependent. In such instances, the regulations will also permit an SEP for the new mother, as someone who has gained a dependent through birth.
WOMEN ALREADY ENROLLED IN FULL-SCOPE OR EXPANSION MEDICAID
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What Delivery Costs And After
Most health plans will cover much of the costs of delivery and aftercare, but, as with any other stay in a hospital or other health care facility, you may need to pay part of the bill. Your costs may include having to meet your health planâs deductible as well as copays or coinsurance.
Your deductible is the money you have to spend before your insurance helps pay for your care.
Copays are a flat fee you pay when you see a doctor, such as $20 per visit.
With coinsurance, you pay a percentage of the cost of your medical care.
You can find out what services are covered by your plan and what your costs are likely to be by looking at your health plan’s summary of benefits or by calling your insurance company.
Here are some things you might want to look for to confirm whether your plan covers these services, and if so, how much of the bill youâll be expected to pay:
- Labor and delivery services in the setting you choose, such as a birthing center, home, or hospital
How Can I Determine If I Qualify For Medicaid
Qualifying for Medicaid is not as black and white as qualifying for most other government programs. Most government programs have some basic requirements along with very clear income guidelines to help individuals know if they qualify.But Medicaid has many ways that someone can qualifyand even though income makes up part of the eligibility requirements, it is not solely based on that. Even people with the lowest incomes may not qualify for Medicaid if they do not fall into one of the Medicaid groups.
And people who make a middle-range income may qualify if they fit one of the qualifying groups and can fall back on options such as share of cost
If you are pregnant and uninsured, Contact your local Medicaid office to find out if Medicaid is the right option for you.
Compiled using information from the following sources:
1. US Government Information
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How Can I Find Health Plans That Cover My Pregnancy
As mentioned, all Marketplace plans must cover maternity care as an essential health benefit. As a leading licensed insurance broker, eHealth offers a wide selection of individual and family health plans at different price points. We make it easy for you to find affordable care that fits your needs. If youd like to get started, just enter your zip code into our plan finder tool to browse plan options. If you have questions, our licensed insurance agents can help you find customized coverage solutions.
Does Medicaid Or Chip Cover Pregnancies
Yes, state Medicaid and the Children’s Health Insurance Program cover expectant mothers, if they qualify.
State eligibility for these programs vary. Some states incorporate the CHIP program in Medicaid coverage, while others treat them as two separate programs.
Check with your state to find out if you qualify for those programs, which offer comprehensive health coverage at free or low cost.
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Health Care Programs Eligibility
Health care coverage is available to individuals and families who meet certain eligibility requirements. The goal of these health care programs is to ensure that essential health care services are made available to those who otherwise do not have the financial resources to purchase them.
It is very important that individuals and families obtain health care coverage. In Michigan, there are many health care programs available to children, adults, and families. Specific coverages may vary depending on the program and the applicant’s citizenship status . The Michigan Department of Health and Human Services determines eligibility for most of the health care programs that are administered by the State of Michigan).
All of the health care programs in Michigan have an income test, except Children’s Special Health Care Services, and some of the programs also have an asset test. These income and asset tests may vary with each program. For some of the programs, the applicant may have income that is over the income limit and still be able to obtain health care benefits when their medical expenses equal or exceed their deductible amount.
Do Medicaid And Chip Provide Pregnant Women With Comprehensive Health Coverage
Yes, in most but not all states. Full-scope Medicaid in every state provides comprehensive coverage, including prenatal care, labor and delivery, and any other medically necessary services.
Pregnancy-related Medicaid covers services necessary for the health of a pregnant woman and fetus, or that have become necessary as a result of the woman having been pregnant. Federal guidance from the Department of Health and Human Services clarified that the scope of covered services must be comprehensive because the womans health is intertwined with the fetus health, so it is difficult to determine which services are pregnancy-related. Federal statute requires coverage of prenatal care, delivery, postpartum care, and family planning, as well as services for conditions that may threaten carrying the fetus to full term or the fetus safe delivery. The state ultimately decides what broad set of services are covered. Forty-seven states provide pregnancy-related Medicaid that meets minimum essential coverage and thus is considered comprehensive. Pregnancy-related Medicaid in Arkansas, Idaho, and South Dakota does not meet MEC and is not comprehensive.
CHIP coverage for pregnant woman is also typically comprehensive. However, in states where services are being provided to the pregnant woman by covering the fetus, the services may not be comprehensive with respect to the health needs of the pregnant woman.
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Family Planning Only Coverage
You’re eligible to receive 10 months of Family Planning Only coverage after your pregnancy coverage ends, regardless of how it ends . This includes all forms of birth control, permanent methods to stop having children, and health checkups related to receiving birth control. This coverage is automatic.
Can You Switch Insurance During Pregnancy
Switching insurance during pregnancy is possible.
“You can switch insurance plans any time during the open enrollment, or at any point if you have a qualifying life event, regardless of whether or not you are pregnant,” says Dodge.
He also mentions that pregnant women may want to consider switching to a health insurance plan with a lower deductible or higher coverage for hospitalization if theyre able to switch plans before giving birth. This will help lower your out-of-pocket costs.
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Will I Get The Same Coverage No Matter Which State I Live In Or Which Plan I Choose
Not necessarily. The law requires most private health plans to help pay for a basic set of 10 essential health benefits, including maternity and newborn care. But the details of what each plan will cover depends on two things:
- Where you live. Your health plan choices will vary from one state to another, and even within the same state in different zip codes.
- Which health plan you choose. Although all plans must cover the 10 essential health benefits, the details of how services are covered can vary for example, all plans must help pay for prescription drugs, but one plan may cover the brand of medication you use while another does not.
Make sure you carefully review your health planâs summary of benefits, especially to see the specific set of prenatal and maternity services it covers.
Will Medicaid Pay For Primary Insurance Copays
Most Medicaid recipients in Arizona dont owe a monthly premium for the services. Instead, youll only need to make payments while receiving care.
If youre 19 or older, you might have to make small copayments for Medicaid-covered services. You wont have to cover copayments, however, if youre 18 or younger, pregnant, in hospice care, or exempt under certain other conditions.
Arizona Medicaids copayments will be much more affordable than copayments from private insurance companies. Keep in mind that if your primary insurance provider charges a copay to receive services, Medicaid may not cover that. You will need to contact your Medicaid service provider to find out.
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Maternity Coverage Is Still Way Too Complicated
Bethany married her college sweetheart a year and a half ago. But because her husband has had a few different jobs since graduating, most of which were contract positions with lackluster benefits, Bethany opted to stay on her mom’s insurance. Young adults can remain on their parents’ insurance until they’re 26, regardless of marital status.
It seemed ideal: Her parents have had some health issues in recent years, which meant they always hit their deductible. They had no idea about the dependent exemptions until it was too late, Bethany says.
In hindsight, it would be more affordable if Bethany was unmarried and therefore had a lower household income so she could claim Medicaid benefits, or if she taken out her own policy through a marketplace. While there are some federal laws that protect maternity rights, Bethany falls into a loophole.
For years, federal laws have stipulated that employers need to cover maternity care for their employees and their spouses. But there are no laws that specifically state companies have to cover maternity care for adult children because, until the ACA passed in 2009, most employer-based health insurance plans cut off coverage when the children legally became adults or upon college graduation.
There are all these disparate puzzle pieces fitting together and not fitting together.Julie StichThe International Foundation of Employee Benefit Plans
Who Is Eligible For Medicaid
The general guidelines for eligibility for Medicaid are set by the Federal government however, each state sets up their own specific requirements for eligibility and these can differ from state to state.
All States are required to include certain individuals or groups of people in their Medicaid plan.
The state eligibility groups are:
- Categorically needy
- Medically needy
- Special groups
In the categorically needy group, this will cover pregnant women whose income level is at or below 133% of the Federal Poverty level.
In the medically needy group, this will cover a pregnant woman who makes too much money to qualify in the categorically needy group. This means that women, who may have been denied Medicaid before, may be able to qualify now.
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Pregnancy Medicaid And Chip Perinatal
Pregnant and without health insurance?
One of the biggest questions facing pregnant women is how to pay for prenatal care and hospital bills. Fortunately, the State of Texas has insurance programs specifically for pregnant women. Some women may be eligible, even if they already have private health insurance or have not yet obtained U.S. citizenship.
Medicaid for Low-Income Pregnant Women
Medicaid is a health insurance program offered through the state government. A pregnant woman can receive Medicaid benefits during pregnancy and up to two months after birth if she meets certain income requirements. Medicaid covers 100% of the cost of prenatal doctor visits, prescriptions, lab tests, hospital care, labor and delivery, postpartum checkups after leaving the hospital, and other medical care associated with pregnancy. Medicaid will also assist with rides to and from the doctor. Women who already have health insurance but meet the Medicaid income requirements can still apply to help pay for medical bills that private insurance will not cover.
CHIP Perinatal Coverage
The Childrens Health Insurance Program offers perinatal coverage for pregnant women who make too much money to qualify for Medicaid. Unlike Medicaid, pregnant women who have not yet obtained U.S. citizenship are eligible for CHIP. CHIP covers 100% of the cost of prenatal doctor visits, prescriptions, labor and delivery, and postpartum checkups after leaving the hospital.
Applying for Medicaid or CHIP
Discount Medical Plan Organization
If negotiating your own self-pay discount scares you, you can work with a Discount Medical Plan Organization. These companies provide pre-negotiated discounts to their members for a monthly fee.
This isnt true maternity insurance since youre paying the doctor and hospital yourself, but the discount has already been negotiated for you by the DMPO.
Before you enroll, make sure your doctor and hospital participate, as many plans have a severely limited selection of participating healthcare providers. If you haven’t yet selected a doctor or hospital, however, you can limit your selections to providers who participate in the DMPO.
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Consider Shopping For A New Health Plan
Needless to say, the pregnancy loophole can cause major headaches for expectant mothers. If you are pregnant and without coverage for maternity services or childbirth, consider these options:
- An ACA exchanges plan. You can get an individual plan that covers your pregnancy. ACA plans are eligible for cost-saving subsidies based on income.
- A Medicaid or Children’s Health Insurance program plan. This can be an option depending on your income and state. More than three dozen states expanded Medicaid, which raised the income restrictions on Medicaid.
- COBRA could be possible if you or your spouse recently became unemployed.
- Catastrophic health insurance. These plans are available to people under 30. They offer low premiums and comprehensive coverage. However, they have high out-of-pocket costs, which could be a problem during a pregnancy.
- Short-term health plan. These low-cost plans are an option, but make sure to read the fine print. Most short-term plans don’t cover maternity services.
- Once the baby is born, you qualify for a special enrollment period . This means that after you have your baby you can enroll in a marketplace health plan even if its outside the open enrollment period. When you enroll in the new plan, your coverage will be effective from the day the baby was born. Keep in mind that maternity services would not be covered.
Having a baby is costly, so make sure you have the health insurance coverage you need during your pregnancy.
If You Dont Have Health Coverage
- Health coverage makes it easier to get the medical check-ups and screening tests to help keep both you and your baby healthy during pregnancy.
- If you qualify for a Special Enrollment Period due to a life event like moving or losing other coverage, you may be able to enroll in a Marketplace health plan right now. Being pregnant doesnt make you eligible, but the birth of a child does.
- Create an account now to apply for Marketplace coverage through the Open Enrollment Period or a Special Enrollment Period. If you select the option to get help paying for coverage on your application, youll be asked if youre pregnant. Reporting your pregnancy may help you and your family members get the most affordable coverage.
- If you dont qualify for a Special Enrollment Period right now, youll be eligible to apply within 60 days of your childs birth. You can also enroll in 2021 coverage during the next Open Enrollment Period this fall.
- If eligible for Medicaid or CHIP, your coverage can begin at any time.
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Medicaid Letters: Medicaid And Pregnancy
What is Medicaid?
Medicaid is a health insurance program for low income people. It pays most medical costs, including hospital care, doctors visits, prescriptions and prenatal care.
Is there a special Medicaid program for pregnant women?
Yes. It is important for pregnant women to get medical care as early in their pregnancy as possible. Medicaid has a special program called Presumptive Eligibility, which pays for medical care for pregnant women before their Medicaid applications have been approved.
To find out if you are eligible for Presumptive Eligibility, call one of the clinics on the list we have enclosed. People at the clinic can tell you if you qualify. If you do, you can immediately receive medical assistance. The Department of Social Services will make a decision within 45 days of the 1st medical appointment/application being placed.
Is it easier to get Medicaid when I am pregnant?
Yes. Because it is so important for pregnant women to get medical care, you are allowed to earn more money than other people. This is called Expanded Eligibility. Even if you have been denied regular Medicaid, you may be eligible under the expanded eligibility income levels. Any of the qualified clinics can tell you if you are eligible. Contact one of them.
What happens if I am presumptively eligible for Medicaid?
Remember, to be eligible for ongoing medical care you must complete your application for regular Medicaidduring your 45-day period of presumptive eligibility.
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