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.
Maternity Insurance When Already Pregnant
Women attempting to obtain maternity insurance when already pregnant experience a variety of outcomes based on an odd array of factors. Most will find coverage right away, some after a delay, and another unfortunate group may have to fund the entire expense themselves out-of-pocket.
Plans covering maternity care with no waiting period do exist. You may be able to begin coverage right away at the end of the year, or immediately if you experience a qualifying life event.
No Waiting Period
Two forms of maternity insurance with no waiting periods allow you to start while pregnant. The plans both cover prenatal care and labor and delivery claims for services rendered immediately after the policy effective date.
Be aware, both options have exceptions that exclude many mothers-to-be.
- Medicaid provides maternity insurance for already pregnant women with no waiting period. In fact, it may even pay claims 3 months retroactively. However, each state imposes income limits. Medicaid can deny pregnant mothers who earn too much money. The income threshold scales to family size and includes your unborn babies.
- Private health insurance plans must cover a pre-existing pregnancy with no waiting period. However, you can only start coverage during a specified period (see next section).
- Annual enrollment plans begin January 1 of each year
- Special enrollment plans begin the 1st day of the next month
Request a pregnancy health insurance quote here. An agent may contact you to discuss options.
Already pregnant women can begin maternity insurance with no waiting period only during an enrollment period. The annual open enrollment has fixed dates while a special enrollment allows you to begin coverage immediately – if you experience a qualifying life event or live in a state with favorable laws.
Timing and eligibility for the needed flexibility are the key factors.
Personal loans can help higher-income expectant women with funding during the interim. Many will experience a gap in coverage. The hole could last weeks or months. Others will deliver her baby before she is legally eligible to start. It all comes down to timing and flexibility.
The annual open enrollment period purposely limits you from purchasing, dropping, or modifying coverage while pregnant. Health insurance with maternity care and no waiting period for preexisting conditions invites adverse selection.
Unchecked adverse selection would ruin the industry. People would only buy coverage when needed and cancel immediately after. Therefore, the federal government established these three key dates to limit choices, and make the plans affordable for everyone.
- November 1, 2018: enrollment start date
- December 15, 2018: enrollment end date
- January 1, 2019: policy effective date
The due date of your baby determines the months with coverage and the length of any gaps. New plan membership begins every 12 months according to a published schedule. Women conceive throughout the year, and the average gestation concludes within 9 months. Therefore, each woman will experience a different span with and without a plan in place.
|Conception Date||Due Date||Months Covered|
Qualifying Life Events
Already pregnant women can purchase maternity insurance with no waiting period during a special enrollment if they experience a qualifying life event. This means no gaps in coverage before the policy kicks in on January 1. Instead, the plan begins on the first day of the next month.
Obviously, qualifying for a special enrollment period is critically important!
Becoming pregnant is not a qualifying life event for individual health insurance in most states. However, you may be able to start a new policy immediately if you act within 60 days of these events.
- 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
Becoming pregnant is a qualifying life event for anyone living in New York State and perhaps others. A healthcare provider must certify the pregnancy. You can begin right away. Check the rules in your state.
The birth of a newborn baby is also a qualifying life event. Coverage can begin from the day you have your baby – even if you sign up 60 days afterward! However, it is unlikely that the plan will pay for labor and delivery in the hospital – but you should file a claim anyway. Let the insurance company decide whether to approve or deny the claim.
Find the official government list of qualifying life event reasons here.
Teens and young adults under the age of 26 may have medical insurance under their parent’s plan. There is no guarantee that your parents’ plan will cover all aspects of a dependent pregnancy.
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: ACA teen dependent pregnancy
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
Other Help When Pregnant Without Insurance
There are other options to consider when you are pregnant without health insurance and need to see a doctor or get an ultrasound. Proper medical and oral care is critical to the health of mom and her baby.
Request a medical insurance quote determined by your income-adjusted premium and out-of-pocket costs. You still have options to afford to see a doctor, dentist, or getting an ultrasound – even if you were denied Medicaid.
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.
|Poverty Level||Percent Covered|
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.