You are in a tough spot if you are pregnant and without medical insurance and/or short term disability coverage. Pregnancy is considered a pre-existing condition by medical carriers. Finding private coverage while expecting a baby will be very difficult.
Don’t despair. There are options for expectant women who need medical coverage, want to apply for maternity disability benefits, or need to cut costs.
- Federal and state government assistance
- Tax savings opportunities
- Private Programs
Learn about the programs designed to help women in your circumstances. Get educated on your rights.
State Government Programs for Uninsured
State Disability 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. 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.
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.
State High Risk Pools - Women who are expecting have a new option with passage of the health care reform act. If your income exceeds the federal guidelines for Medicaid, then high risk insurance pools might provide the coverage you need.
Beginning September 23, 2010 each state must set up a high risk health insurance pool for people with pre existing health conditions. Pregnancy is considered a pre existing health condition and most private insurers will not issue coverage for you while expecting.
In order to qualify you must show that you have a pre existing condition, that you have been uninsured for at least six months, and that you are in the country legally. At minimum, you will be able to get coverage during the most important time: the third trimester, and during delivery.
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.
Federal Government Assistance for Pregnant Women
Pregnancy Discrimination Act - Your best bet may be to change employers. 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.
Health Insurance Portability and Accountability Act (HIPAA) - HIPAA 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.
Affordable Care Act - Help is coming soon from the Affordable Care Act, but it won’t arrive until January of 2014. The new law requires that insurers cover any pre-existing condition, and that all health plans cover “essential health benefits”. These essential benefits include prenatal care, and hospitalization. Pregnant women conceiving after April 1 of 2013 may expect to give birth when the law becomes effective. Make sure you purchase a plan during open enrollment, which begins in October of 2013.
Tax Savings Opportunities for Pregnancy Expenses
Tax Deductible Expenses – Many of the expenses for your prenatal care and hospital stay that are not covered by insurance may be tax deductible.
Flexible Spending Account - 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.
Private Alternatives to Reduce Costs
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.
Alternative Medical Treatment - 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.