Health insurance open enrollment periods make pregnancy a hit or miss proposition for many parents-to-be. While you can purchase a new plan covering pre-existing conditions with no waiting period, you cannot do so at your convenience.
You must wait until government laws and employer rules say you can make modifications. For some, the timing works just fine while others find that the preset dates do not mesh with their needs.
- Rules for switching plans outside of designated dates
- Election and effective dates for private and group coverage
Changing Insurance for Pregnancy Outside of Open Enrollment
Changing health insurance for pregnancy outside of open enrollment period is a tricky subject. When you are expecting, having the right plan in place can translate into significant savings, and may be crucial for the welfare of mom and her newborn baby.
Those expecting to deliver shortly after open enrollment have far more options because they can apply for an optimal plan during this designated period. However, if your due date falls just before the designated dates, you can make modifications only if you experience a qualifying life event, or qualify for Medicaid.
Request a health insurance quote once the timing is right for you. The form will ask if you have experienced a life event in the last thirty days. Use the information on this page to guide your response. Choose a design that makes sense for a family with high utilization.
Qualifying Live Events
If you experience a qualifying life event, you may be eligible to purchase your medical insurance plan outside of open enrollment during a special enrollment period. Becoming pregnant is not considered a qualifying life event for health insurance, but you may be able to make changes within 60 days if any of the following pertains to you.
- Involuntary loss of other coverage
- Individual plan renewing outside of designated times
- Becoming a dependent or gaining a dependent because of birth, adoption, or placement in foster care
- Becoming a US citizen
- A permanent move where different qualified plans are available
- An enrollment error that was not your fault
- Employer-sponsored plan reduces benefits making it not provide minimum value or raising the cost so that it is unaffordable
Buying or Cancelling Coverage
When buying medical insurance for pregnancy, apply common sense rules regardless of where your due date falls relative to open enrollment. Remember that while prenatal care is very important, labor and delivery in a hospital are where most costs occur. If your baby delivers preterm, a NICU stay can generate extremely large bills.
Keep these thoughts in mind when buying a new policy for maternity needs.
- High-deductible plans save money on premiums but may leave you with more leftover medical expenses after you deliver.
- Federal government subsidies may help you find a far more affordable plan if you meet income guidelines.
- Out-of-pocket medical costs may be very high if you select a plan where your gynecologist, hospital, and local NICU are out-of-network with your plan.
Many families look to cancel their plan after giving birth. If mom and baby are both healthy, it can be tempting to save money on premiums now that regular doctor visits and a hospital stay no longer loom on the horizon.
You can cancel an individual plan outside of designated dates without replacing simply by stopping premium payments, or by contacting the carrier. However, you run serious financial risks if someone in your family experiences an illness or injury, and you may have to pay a fine.
You cannot cancel a group plan outside of designated dates unless you get a new job, become a new employee, quit, and become terminated or unemployed.
If you are pregnant without insurance, Medicaid provides coverage for approximately 40% of expectant women in the United States. Each state has different rules for income eligibility; however, one rule is constant regardless of where you live. Expectant women can obtain coverage anytime during the course of the year, with no open enrollment restrictions.
Health Insurance Open Enrollment Periods
When you consider health insurance open enrollment periods relative to pregnancy, you begin to see how your projected due date affects your outcome. For many women and families, it comes down to luck.
Most private plans operate with an annual open enrollment, which allows members to make changes once every twelve months, while a normal gestation completes in nine months. The timing and rules depend on whether you take advantage of individual plans or group employer coverage.
Unless you have a qualifying life event, you may find yourself having to wait before getting coverage until the annual individual health insurance open enrollment. The Affordable Care Act is the primary law that governs when you can do this and sometimes allows for extensions.
Laws of Chance
The law dictates that individuals can switch plans only during specific open enrollment periods. The plans become effective on subsequent dates according to a published schedule.
|Selection Date||Effective Date|
|Nov 1 thru Dec 15||Jan 1|
|Dec 16 thru Jan 15||Feb 1|
|Jan 16 thru Jan 31||Mar 1|
Notice that the available period spans three months, which leaves nine months during the year when you cannot make alterations. Nine months matches the normal term of gestation. This creates a variety of different outcomes based upon date of conception and due date
Twelve percent of babies deliver preterm. Many women do not realize they are expecting right away, or may not begin thinking about getting appropriate coverage until months later. Each factor narrows the window of opportunity.
|Feb 1||Nov 1||No *|
|Mar 1||Dec 1||No|
|Apr 1||Jan 1||Maybe **|
|May 1||Feb 1||Maybe|
|June 1||Mar 1||Maybe|
|July 1 – Oct 1||Apr 1 – Jul 1||Yes|
|Nov 1||Aug 1||Maybe ***|
|Dec 1||Sep 1||Maybe|
|Jan 1||Oct 1||Maybe|
* Entire span of prenatal period occurs outside of designated dates
** Baby may deliver before earliest effective date if preterm
*** Mom may neglect to alter plans during the first trimester
During 2015, the government allowed for several one-time open enrollment extensions to accommodate those unaware of the new rules. Do not count on extensions or exceptions during 2016, 2017, 2018, and beyond. If you are expecting a baby, make your choices during the designated periods.
The open enrollment rules for employer-based group plans are much stricter when applied to switching health insurance while pregnant. Expect to find greater variation in dates, and narrower windows for making elections as each employer set the rules, not a centralized government authority.
Your employer will send a letter announcing the timing and rules for your open enrollment. The notice should indicate the start and finish dates for when you can make elections, and when the new coverage becomes effective.
In general, the election periods occur most frequently in the last quarter of each year, but not always. Many employers choose times in other months. Most offer a one-month period, which leaves eleven months during which you cannot alter your choices. This highlights the need to opt in when you have the opportunity.
COBRA provides the option to continue with your group plan in the event that you change employers or become unemployed. COBRA premiums are often shockingly high as you lose the employer subsidy and the benefits of pre-tax payroll contributions.
This modification in premium cost triggers a qualifying life event and may enable you to qualify for government subsidies when purchasing a plan through a state exchange.