The options for being pregnant without health insurance have expanded greatly since 2009. Passage of the two new laws (Patient Protection and Affordable Care Act, and American Reinvestment and Recovery Act) has opened up several new avenues.
Each state implements these new regulations differently, so your home state can make a big difference in where to go when pregnant without health insurance. Consider every option now available.
- Options for direct coverage
- Affordable Care Act
- When denied Medicaid
- Options for income replacement
- Options for cost savings
Coverage Options when Pregnant without Insurance
Passage of the Affordable Care Act opened new options for where to go when pregnant without health insurance. The law requires traditional health insurance plans to cover preexisting conditions with no waiting periods. But the law allows states to decide whether to accept Medicaid expansion, creating a different set of alternatives based upon location.
The same does not hold true for supplemental maternity insurance, which is not subject to this regulation. Options for income replacement still exist in some states. See below for more details. Three viable alternatives now exist to cover women who became pregnant without health insurance already in place: employer group coverage, Medicaid, and Affordable Care Act compliant coverage.
Group Health Insurance
Group health plans are sometimes required to cover pre-existing conditions when the gap in coverage does not exceed 63 days. The Pregnancy Discrimination Act requires that any medical benefit plan provided by an employer must cover expenses for pregnancy-related conditions on the same basis as costs for other medical conditions.
HIPPA limits the ability of group health insurance plans to exclude preexisting conditions from coverage. Pregnant women are a protected class under this legislation. Make sure you follow the rules carefully.
Medicaid is a state and federal program that pays for some health services for certain low-income pregnant women, and children. Each state has differing income limits, and guidelines for who qualifies. The average income limit is around $30,000 per year.
Getting accepted by Medicaid is your hardest step. Call the human resources department or social services in your county, and explain that you are calling for a Medicaid for pregnant women application. Once qualified you should then find a doctor who accepts Medicaid patients. Women are covered for all care related to the pregnancy, delivery and any complications that may occur while expectant and up to 60 days postpartum.
Affordable Care Act
The Affordable Care Act may now provide a good alternative for women who make too much money, and don’t qualify for Medicaid. If you are pregnant without insurance and were denied Medicaid there are several important items to know: you can purchase coverage during an open enrollment, and you may be eligible for subsidies.
Open Enrollment Periods
Maternity insurance under ObamaCare allows women who are already expecting to purchase health insurance covering maternity and newborn care. Coverage begins immediately with no waiting periods.
You must enroll in the plan during an open enrollment period. The initial open enrollment period began on October 1, 2013 and ends on March 31, 2014. The second open enrollment period is much shorter October through December of 2014.
Eligibility for Subsidies
Women who don’t qualify for Medicaid because they make too much may qualify for premium and cost sharing subsidies under ObamaCare plans. Subsidies begin for people making 100% of the federal poverty level and end for those earning more than 400%.
However because of the state option to expand Medicaid some women may fall into the Medicaid gap. They may make too much money to qualify for Medicaid, and too little to qualify for subsidies. If you live in a state that has not agreed to expand Medicaid you may fall into this gap. These are the states yet to expand Medicaid as of December 2103.
|Montana||Nebraska||New Hampshire||North Carolina||Oklahoma|
|Pennsylvania||South Carolina||South Dakota||Tennessee||Texas|
Options for Income Replacement without Insurance
Lost income can become a problem if you experience complications and miss work for an extended time before your delivery and while on maternity leave. Postpartum problems may delay a return to work. Most employers do not provide paid maternity leave benefits. Women who are pregnant without disability insurance have a handful of options courtesy of several state-based maternity leave laws in the U.S.: state disability, paid leave laws, and unemployment compensation.
If you but work in one of five states with mandated state disability you may qualify for income support during the time you are unable to work. The five states with mandated short term disability insurance are California, Hawaii, New Jersey, New York, and Rhode Island.
Paid Family Leave
Three states provide for income replacement for employees who need to care for sick family members. Those states are California, New Jersey, and Rhode Island.
The passage of the American Recovery and Reinvestment Act provided state level incentives for “modernization” of unemployment compensation to include “compelling family reasons”. Twenty two states accepted these incentives and expanded their programs. Six states defined a compelling family reason to include an employee’s own disability. Those states are: Arkansas, Illinois, Maine, Minnesota, Texas, and Washington.
Cost Saving Options when Pregnant without Insurance
Finally there are a variety of cost-saving options for women who are pregnant without health insurance. Every penny counts when you are expecting. There are even options for women who need an ultrasound if you know where to look.
You may be facing some extra medical bills. Your un-reimbursed medical expenses for prenatal care, your hospital admission, testing, and monitoring may be tax deductible. Use pre-tax dollars rather than after-tax dollars to pay for these costs with your Flexible Spending Account (FSA). You may cut your costs by 1/3 or more for many of your costs of carrying and delivering your baby.
Many faith based organizations exist to provide support and education services for women with unplanned pregnancies. Their mission may be to provide alternatives to abortion. Many centers provide free or low cost ultrasounds to confirm a pregnancy.
Medical discount plans are another alternative. They will provide discounts at your doctor, specialists, and for lab work. They also have a hospital advocacy program that may work with your hospital to negotiate the bill down for you. Consider these programs as coupons that may save thousands of dollars.
If you are having a normal, uncomplicated experience you may want to consider using a birthing center rather than going the traditional OB/GYN and hospital route. Your costs will be much lower. You will be treated by experienced midwives for your prenatal appointments, childbirth classes, the birth, and postnatal care. Most centers are located near hospitals in case one is needed.
Charity Care - You may also consider investigating charity care. Many states mandate that hospital systems provide treatment for people who need care. Like Medicaid the amount of healthcare you receive during while carrying your baby may vary based upon your income. Contact your local hospital systems for more information about program benefits and costs.
Women Infants and Children (WIC) is a federally funded program which provides states with money to assist certain low-income women who are expecting, along with infants and children who might have nutritional needs. You may be able to get assistance and aid to purchase supplemental foods, get referrals to health care professional, plus nutrition education.
Contact your local state or county agency to set up an appointment with a WIC counselor. These government programs have been established to help women in difficult circumstances. Make your resource go further to support your health, and the welfare of your child.