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 for financial assistance.
Each state implements these new regulations differently, so your home state can make a big difference in where to go when pregnant without insurance. Consider every option now available.
- Options for traditional healthcare
- Alternatives for income replacement
- Opportunities for cost savings
Medical Care 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 plans to cover preexisting conditions with no waiting periods, subject to waiting period restrictions.
Your monthly premium costs may surprise you relative to what a policy might pay in benefits. Premium and cost-sharing subsidies vary by income and state of residence, and can make carrying your baby to term far more affordable.
Three viable options now exist to cover women who became pregnant without health insurance already in place: individual plans bought privately, employer group coverage, and Medicaid.
Individual Health Insurance
If you are pregnant without health insurance, do not qualify for Medicaid, or your group plan does not cover maternity because you are a dependent, there are several important items to know: you can purchase individual health insurance covering prenatal care, hospitalization for labor and delivery, plus newborn care during an open enrollment, and you may be eligible for subsidies.
Open Enrollment Periods
You must enroll during open enrollment unless you qualify for a special enrollment period. Open enrollment begins on November 1 of each year and concludes on January 31 of the following year. You may be eligible for a special enrollment if you recently experienced a qualifying life event.
Eligibility for Subsidies
Government subsidies may reduce your overall costs. Subsidies begin for women making 100% of the federal poverty level and end for those earning more than 400%. The subsidies may make your premiums more affordable, and may reduce your amount of unreimbursed medical expenses.
However, some women may fall into a subsidy 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 eligibility criteria, they may deny your application. These are the states where this may apply.
|New Hampshire||North Carolina||Oklahoma|
|Pennsylvania||South Carolina||South Dakota|
Group Health Insurance
If you are pregnant without health insurance, employer group coverage is a viable option thanks to two separate laws governing these plans. If you can find a new job, you may be able to obtain affordable healthcare.
The Pregnancy Discrimination Act requires that any medical benefits plan provided by an employer must cover expenses for pregnancy-related conditions on the same basis as costs for other medical conditions. You cannot have a gap of more than 63 days.
HIPPA limits the ability of group health insurance plans to exclude preexisting conditions from coverage. Pregnant women are a protected class under this legislation. Carriers cannot exclude benefits for a pregnant woman even if she did not have prior coverage before enrolling.
If you are pregnant without health insurance, Medicaid may be your best option. It is a state and federal program that pays for health services for 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.
Acceptance 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.
Medicaid covers women for all care related to the pregnancy, delivery and any complications that may occur while expectant and up to 60 days postpartum.
Alternatives When Pregnant without Disability Insurance
If you are pregnant without 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. Postpartum problems may delay a return to work.
Most employers do not provide paid maternity leave benefits. You must purchase private policies prior to conception. Most expectant women find that they missed the boat on any form of paid leave.
State-based financial assistance programs can sometimes help. Each state has unique laws, which may apply based on where you work or where you reside. Very limited alternatives exist such as state disability, paid leave laws, and unemployment compensation.
If you are pregnant without disability insurance, your state is not likely to be of much help. Only five states have a mandatory program addressing temporary medical conditions. This means that 45 states offer nothing for women taking leave from work to have a baby.
You must work in one of these five states to qualify. These are the five states with mandated temporary disability programs.
- New Jersey
- New York
- Rhode Island
Paid Family Leave
If you are pregnant without disability insurance, do not look to your state for paid family leave benefits unless you work in one of the three with such a program. This means 47 states do not provide income support for parents wanting to spend time at home to bond with their newborn.
Three states provide for paid family leave benefits for employees who need to care for a newborn baby at home. Those states are California, New Jersey, and Rhode Island.
If you are pregnant without disability insurance, do not expect that you can collect unemployment compensation while you are unable to work, unless you work in one of six states with a liberal definition of “compelling family reason.”
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 Opportunities when Pregnant without Insurance
Finally, there are varieties of cost-saving opportunities for women who are pregnant without medical insurance. Every penny counts when you are expecting. Take full advantage of every possible tax saving chance, private discount plans, and government assistance.
Your un-reimbursed medical expenses for prenatal care, your hospital admission, testing, and monitoring may be tax deductible. If you are pregnant without medical insurance, you may be facing some extra medical bills.
- Use a Flexible Spending Account to pay for these expenses using pre-tax dollars rather than after-tax dollars. You may cut your costs by 1/3 or more for many of your costs of carrying and delivering your baby.
- Use Schedule A to deduct these expenses at the end of the tax year. Savings begin after reaching a threshold of 10% of your adjustable gross income.
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.
If you are pregnant without maternity insurance, several private opportunities exist to help you lower your costs of carrying your baby to terms, such as discount plans and birthing centers.
- Medical discount plans provide savings 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.
- Birthing centers work well if you are having a normal, uncomplicated experience. Experienced midwives take care of your prenatal appointments, childbirth classes, the birth, and postnatal care. Most centers are located near hospitals just in case.
If you are pregnant without getting insurance, several government programs provide financial assistance to help you afford to carry your baby to term.
Charity care is a form of government mandated financial assistance. Many states mandate that hospital systems provide treatment for people who need care. 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 a 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 help women in difficult circumstances. Make your resource go further to support your health and the welfare of your child.