Women have several options for finding pregnancy health insurance without waiting periods for preexisting conditions. Each alternative covers services immediately after the policy effective date.
The critical question is: when does the coverage begin!
The public arena offers two alternatives that start right away. Medicaid covers low-income families, and CHIP includes some mid-income mothers.
The private marketplace offers coverage that starts on January 1. This alternative works well if your due date falls in the early months of the year – or if you experience a qualifying life event.
Therefore, two rules about special enrollment periods could be the key to success: change of residence and marital status.
Public Maternity Insurance without Waiting Periods
Medicaid and CHIP are the public health insurance options that offer maternity coverage and no waiting periods. Low-income women who are already expecting a baby can enroll at any point during the year and obtain immediate benefits for their preexisting pregnancy.
Medicaid is a public health insurance program covering 40% of already pregnant women without a waiting period for preexisting conditions. You could qualify for one of three coverage levels with benefits that begin right away and do not have set enrollment periods.
However, pay close attention to details because Medicaid can deny pregnant women who earn too much or do not meet legal residency requirements.
Full-scope Medicaid provides immediate maternity coverage to women who meet the strictest income and citizenship criteria. Under presumptive eligibility, you can begin receiving care right away, and your plan might honor claims three months retroactively.
The full-scope option covers pregnancy-related care plus treatment for other medical problems such as accidents and illnesses. Also, the coverage continues indefinitely with periodic recertification.
However, only those with the lowest incomes qualify, and each state has different parameters based on the percentage of the Federal Poverty Level.
- Lowest: 18%
- Highest: 138%
Pregnancy Medicaid provides immediate maternity insurance to women legally in the country whose household income is slightly higher. However, the benefits are restricted and end sixty days after childbirth.
The limited-pregnancy option covers prenatal care, labor and delivery, postpartum services, pediatrics, and treatment for the mother’s general health.
Once again, the state where you reside might have different rules based on the Federal Poverty Level.
- Lowest: 138%
- Highest: 380%
Emergency Medicaid provides immediate benefits to undocumented immigrants who need critical maternity coverage. The program does not include routine services such as prenatal care, ultrasounds, or breast pumps but does cover urgent needs such as labor and delivery in a hospital.
The Children’s Health Insurance Program (CHIP) also provides maternity coverage without a waiting period. CHIP is a public program that might help women with preexisting pregnancies who earn too much to qualify for any of the Medicaid programs noted above.
While you do not have a set enrollment period for CHIP, only select states extend coverage to pregnant women. Contact your state office for details if you live in one of these regions.
Private Maternity Insurance without Waiting Periods
Private health insurance can cover pregnancy with no waiting period for women who make too much to qualify for Medicaid. However, the coverage works more like a lottery system based on your expected due date – unless you have a qualifying life event.
Women who are already pregnant can purchase maternity insurance with immediate benefits for preexisting conditions with one big caveat – when the policy starts. Therefore, the critical consideration is the coverage-effective date.
Private pregnancy health insurance with no waiting period begins on January 1 for women who do not have a qualifying life event (see below). Because of the start date rules, some women might get lucky or strike out based on their expected due date.
|Lucky Due Dates||Unlucky Due Dates|
By law, the new policy must cover all preexisting health conditions immediately. However, a nine-month pregnancy could end before the annual (twelve-month) enrollment rolls around.
Private pregnancy health insurance with no waiting period for preexisting conditions can begin right away for women who have a qualifying life event. In this case, a special enrollment enables you to sign up for coverage that begins any time during the year.
The rules for qualifying life events are especially critical for women with September through December due dates and fall into four categories.
- Loss of health coverage
- Changes in household
- Changes in residence
- Other reasons
Marrying your boyfriend is one way to get pregnancy health insurance without a waiting period to start any time during the year. A change in household status due to marriage triggers a qualifying life event and makes you eligible for a special enrollment period.
Marrying the father of your unborn child is a big step and a long-term commitment. Therefore, weigh the pros and cons carefully, but schedule the wedding for an early date to get your coverage started in time.
Changing your address is another way to obtain health insurance covering pregnancy without a waiting period. In this case, the public option is more likely to begin any time during the year than the private alternative.
- Moving to a state with higher income limits for public Medicaid could provide immediate maternity benefits. For example, Idaho residents with a two-member household income above $24,000 could relocate to a neighboring state with more lenient earnings criteria.
- Oregon: $32,756
- Washington: $34,135
- A change of address is a qualifying life event for private insurance, making you eligible for a special enrollment. However, you must prove you had coverage for one or more days during the 60 days before your move.
Women who live in New York or Maryland can obtain insurance without a waiting period at any time during the year. Both states include preexisting pregnancy as a qualifying life event.
The recent changes in state laws permit coverage to begin immediately via a special enrollment period. Verify the rules if you live in these regions.
Women seeking maternity insurance when already pregnant need coverage without waiting periods for preexisting conditions – otherwise, they might have to skip critical services such as prenatal care or childbirth in a hospital.
Public plans, such as Medicaid and CHIP, can begin any time during the year. You must still fit the qualifying criteria: be in the country legally, and show household income below the limit designated by your state.
Private plans fit the needs of women with higher incomes; however, they begin January 1 – unless you have a qualifying life event that makes you eligible for a special enrollment period. Marrying your boyfriend and changing your address can get you started right away if your due date falls late in the year.