Take a deep breath and relax if you find yourself pregnant without health insurance. There are several options to find maternity insurance once you are already pregnant.
However, you must learn about two important topics.
Women who make too much money to qualify for Medicaid can purchase a private plan with no waiting periods.
Expectant mothers can begin coverage any time of year if she experiences a qualifying life event such as marrying the father, moving to a new zip code, or becoming a US citizen.
Pregnancy Health Insurance No Waiting Period
Expectant women have several options for finding pregnancy health insurance without waiting periods. The alternatives cover prenatal care and labor and delivery claims for services rendered immediately after the policy effective date – and sometimes before.
Medicaid is the preferred option because of the low cost, retroactive benefits, and instant signup. Private plans also help some expectant women right away – but not the majority.
The first thing you need to know that companies cannot consider pregnancy as a pre-existing condition for health insurance. Under the Affordable Care Act, private healthcare plans must cover all maternity-related conditions without a waiting period. Also, the company cannot deny coverage because you are already expecting a baby.
However, while pregnancy is not as a pre-existing condition, you also cannot sign up for private health insurance any time you want. You can only start coverage during an enrollment period.
- Annual open enrollment has a January 1 effective date. You can elect coverage from November 1 through December 15 of the previous year.
- Special enrollment periods begin any month of the year. You choose the plan within 60 days of a qualifying event, and the coverage becomes effective on the 1st day of the next month.
Clearly, the special enrollment period offers the best maternity coverage without a waiting period while the annual enrollment does not – unless you find this article during November or December. However, you must experience a qualifying life event to take advantage of the special enrollment period.
Qualifying Life Events
Pregnancy is not a qualifying life event for private health insurance under the Affordable Care Act. This means that expectant women must have a different reason to be eligible for maternity coverage without waiting for the annual enrollment.
The rules vary slightly for individual plans, group coverage at work, and after you have your baby.
Below are the qualifying life events that make you eligible for a special enrollment period in the individual marketplace.
- Involuntary loss of other coverage
- Marrying the father of the baby
- Moving to a new zip code
- Becoming a US citizen
- An enrollment error that was not your fault
Request a pregnancy health insurance quote if you meet one or more of these conditions. An agent may contact you to discuss options.
- You experienced a qualifying life event in the last 60 days
- It is now November or December (annual enrollment)
- You live in New York State and enjoy lenient rules
New York insurance law defines pregnancy as a qualifying life event. Also, verify the rules in your state as laws change frequently. Find the official federal government list of suitable reasons here.
The list of qualifying life events for employer-based group health insurance is similar – but with one key difference. New employees qualify for special enrollment (at any time of year) after satisfying the employer’s probationary period.
Each employer chooses its own probationary period. The period could be 0 days, 30 days, 60 days, 90 days, or longer. Therefore, finding a new job that offers health insurance is another option for getting maternity insurance without a waiting period.
Having a Baby
Having a baby is also a qualifying life event for health insurance. After childbirth, you have 60 days to add your newborn to an existing plan, or to purchase an individual policy for your child.
However, the change must be consistent with the event. This is not an opportunity to get coverage for mom. The new plan is unlikely to pay for labor and delivery in the hospital
Medicaid provides maternity insurance for already pregnant women with no waiting period. In fact, this public coverage may even pay claims 3 months retroactively. Review the rules in your state when signing up.
In addition, Medicaid does not impose any type of enrollment period restrictions. You can begin coverage right away without having to wait until January. Also, you do not have to experience a qualifying life event in order to start in the middle of the year.
However, each state imposes income limits. Medicaid can deny pregnant mothers who earn too much money. The income threshold scales to family size and can include your unborn babies. See below for options if you do not qualify.
Maternity Insurance When Already Pregnant
There are other options to consider for maternity insurance when already pregnant. You can possibly find help with prenatal care, ultrasounds, and labor and delivery for childbirth. Proper medical and oral care is critical to the health of mom and her baby.
The federal government provides income-based subsidies for women who make too much money to qualify for Medicaid. Also, your parent’s plan could provide coverage. In addition, state programs can help during your maternity leave.
Will your parent’s insurance cover your pregnancy? Dependent pregnancy coverage is an issue for teens and young adults under the age of 26 who rely on their parent’s plan. Unfortunately, there is no guarantee that your parents’ plan will cover all aspects of your care while expecting.
This is an obvious first place to look. However, do not assume comprehensive maternity coverage. Make sure that you ask the right questions the right way to the right people.
Approximately 70% of employer-based group health insurance plans do not cover dependent pregnancies. This means that many teenage and young adult daughters may have to consider alternatives.
Two federal laws weigh in on the issue and leave significant gaps.
- The Pregnancy Discrimination Act requires group health care plans to cover prenatal care and related services. However, this requirement does not extend to dependents.
- The Affordable Care Act requires group plans to cover preventive prenatal care for dependent pregnancies. However, this does not extend to the far more expensive hospitalization for labor and delivery.
Source: Sexual Health Initiative for Teens
Be careful to ask the right questions about coverage for dependent pregnancy. Each insurance company issues a variety of plans in the group, individual, and public marketplace. Every plan works differently even when issued by the same company.
Contact the carrier and ask about dependent pregnancy coverage for the specific plan that your parents have. Do not assume that the rules apply evenly across all plans issued by any of these named insurance companies.
- Blue Cross Blue Shield (BCBS)
- Kaiser Permanente
- United Healthcare
Don’t Qualify for Medicaid
Many women who are pregnant without insurance make too much money to qualify for Medicaid – or think that they do. Consider these options if you need to see a doctor and cannot afford the expense.
- Limited Pregnancy Medicaid has higher income limits than regular Medicaid does. Do not assume that you make too much money to qualify. You could be looking at the wrong set of limits or applying household size rules improperly. Each unborn baby counts as an additional family member. Apply at your county office and make them issue the denial.
- Women denied Medicaid because they make too much money often still qualify for subsidized private health insurance. The federal government provides two forms of financial support that make it more affordable to pay for prenatal care and deliver your baby in the hospital.
Women who make too much to qualify for Medicaid often meet premium reduction requirements. These subsidies come in the form of tax credits that are either advanced or refunded and cap the percentage of income you must spend on individual health insurance premiums. The percentage depends on income relative to the federal poverty level.
Women denied Medicaid might also meet cost-sharing reduction requirements. These subsidies reduce what you must pay out-of-pocket for a silver-level plan which typically covers 70% of average expenses. Once again, the level of cost reduction depends on income relative to the federal poverty level.
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Women who are pregnant without insurance and needing an ultrasound do not have to look far. The ultrasound (sonogram) uses sound waves to image the developing baby and the mother’s reproductive organs to detect possible abnormalities.
Faith-based pregnancy resources centers across the country provide free ultrasounds for expectant women. Licensed practitioners perform and interpret the results in a licensed medical facility. They perform this service at no charge in order to help mothers decide to choose life for her baby.
Use the free ultrasound image as positive proof of pregnancy when applying for Medicaid.
Being pregnant without dental insurance is surprisingly important and offers several options to help pay for treatment. You do not want to skimp on oral care while expecting a baby.
Pregnancy hormones cause the gums to swell and bleed. Swelled gums trap food causing increased irritation in your mouth. The irritation can lead to infections and gum disease. Gum disease is associated with pre-term birth.
Regular cleanings (prophylaxis) can minimize these risks. These options can help pay for dental work.
- Medicaid covers comprehensive dental care in many states
- Health insurance covers medically necessary dental work
- Dental plans have short waiting periods for preventive care
Women working in certain states have fewer concerns about being pregnant without maternity leave pay or legal job protections. It is important to have a backup source of income during the period when you must stop working before and after delivery. In addition, it helps a great deal if your employer must hold your position open until you return.
State-based financial assistance programs often help parents with workplace issues.
- The federal Family Medical Leave Act applies across the country
- 12-weeks of unpaid job protections
- 50 + employee businesses
- Paid family leave programs exist in four states
- New Jersey
- New York
- Rhode Island
- Temporary disability covers mom’s pregnancy leave
- New Jersey
- New York
Parents can collect unemployment benefits after maternity leave in 22 states after they are able and available to return to the workforce. Large states such as Texas, Illinois, Washington, Wisconsin, and others relax requirements for people who quit for a compelling family or good cause reason.