One important feature of PPACA is that pre-existing conditions are no longer excluded. This feature is a crucial element for women who are already pregnant when seeking coverage. Open enrollment periods are designed to prevent people from taking advantage the system by enrolling only when needing healthcare.
In theory, the two features balance out. The timing at first seems intentional, and then outcomes become random:
- The 2013 open enrollment period is designed to help all pregnant women get health insurance.
- The 2014 open enrollment period is less gracious, and leaves one third of already pregnant women uninsured.
PPACA Open Enrollment Rules
The two counter-balancing features create an odd effect for families needing maternity coverage under Obamacare. See how this works by exploring: PPACA open enrollment rules, qualifying life events, charts for 2013 and 2014 open enrollments.
Open enrollment begins on October 1, of 2013 and concludes March 31, of 2014. This is the period of time when people can enroll in an individual health plan through their home state health insurance marketplace.
Don’t confuse these open enrollment periods with the timing to choose health insurance through your employer’s group plan. Each employer has a unique open enrollment timeframe, most of which do not coincide with the PPACA timeframes for individual coverage. While most employers conduct open enrollment during the 4th quarter of each year, many schedule theirs at other times.
If you fail to make a positive election during the open enrollment period you will be excluded from purchasing coverage until the next open enrollment in the subsequent year – even if you are pregnant and need insurance. That coverage will not begin until January 1 of the following year. The only exception to these rules occurs if there is a qualifying life event.
Qualifying Life Events
There is some leeway to make changes to your elections outside of the open enrollment period. Outside of IRS guidelines for group plans, it is difficult to find any ruling on how this will work in state exchanges. Based on these pre-existing rules you may be able to make changes that are consistent with a change in family status:
- Marriage, divorce, annulment
- Birth, adoption, foster child
- Last child loses coverage
- Death of spouse or dependent
Rather than review every possible qualifying life event, we want to focus on the birth of a child. The PPACA provides ten essential health benefits which include maternity and newborn care. When your child is born, the newborn care benefits are expected to kick in automatically for thirty days (as they did with most health insurance plans prior to passage of the law).
If you chose a family plan or a parent/child plan during the initial open enrollment, you simply need to contact your insurance company and add your newborn to the policy. There may be a modest change in premium costs, as insurers are allowed to vary premium by number of covered lives.
If you chose an individual plan, you will need to upgrade your policy to a parent/child plan. You have thirty days to make this change.
Finding out that you are pregnant is not on the list. Don’t assume you can buy a policy at any time because the Affordable Care Act promises to cover preexisting pregnancies. It does, but with limits. Open enrollment is that limiting factor.
2013 ACA Open Enrollment Periods Chart
A chart is worth a thousand words. The initial open enrollment lasts for six months, and extends three months into 2014. That leaves exactly nine remaining months for coverage to be effective in 2014. This is the seemingly intentional part of the open enrollment rule. It seems designed to make sure that pregnant women are given every opportunity to get covered.
There are three key points relating to maternity coverage that this chart illustrates:
- Any women due to give birth during 2014 can purchase a policy during open enrollment regardless of when she conceives.
- Women with due dates early in 2014 have more time to make a decision.
- Women with dues dates late in 2014 have a short window of time to decide and must move quickly.
2014 ACA Open Enrollment Periods Chart
The 2014 open enrollment period works differently, and creates random outcomes for pregnant women. The enrollment opens on October 1st, and closes on December 7th. The enrollment period is shortened from six months, the just over two.
It appears lawmakers allowed a special one-time-only grace period for pregnant women for the 2013 open enrollment. Now the consequences of getting pregnant without insurance are much higher depending upon when you conceive.
Consider this very random set of consequences driven exclusively by date of conception and/or due date:
- One third of women will conceive during a timeframe when they can’t purchase maternity coverage.
- They conceive outside the open enrollment period
- They deliver before the next coverage effective date – January 1, of 2015
- They will remain uninsured if they did not previously enroll in a health plan.
- Two thirds of women will be expecting during a the 2014 open enrollment timeframe
- They are eligible to enroll in plans covering maternity effective January 1, of 2015
- They are due to deliver in 2015
- Most pregnancy related expenses occur during delivery