If you're married and pregnant, your eligibility for health insurance depends on a number of factors: namely, whether you and/or your spouse already have health insurance, and if so, whether your plan covers critical services such as prenatal visits, ultrasounds, lab work, hospital and delivery charges, as well as post-natal check-ups. Starting January 2014, provided you've signed up and haven't had the baby yet, an array of new maternity options may be available to you.
Pregnancy as Preexisting Condition
As of June 2013, getting your maternity bill covered depends on whether you or your spouse already have health insurance that includes maternity coverage before you got pregnant. While changes are on the way, obtaining coverage after getting pregnant could cubbyhole you as having a preexisting condition. The Health Insurance Portability and Accountability Act (HIPAA) ensures that if you change insurance plans while you are pregnant, your new health insurance provider cannot deny you coverage on the basis of a preexisting condition (i.e. pregnancy), as long as the plan includes maternity care. However, this only applies to group health insurance and not individual plans.
Spousal or New Employer Insurance
If you don't have health insurance with maternity coverage but your spouse does, or if you do have health insurance for maternity expenses but you prefer your spouse's plan or a different health provider, you may be able to hop aboard his employer's plan or switch to a different plan after pregnancy. However, you may face waiting periods of a month or more -- which could be dicey if you're far along in a late trimester -- or your rates could go through the roof. If you switch jobs, you could extend your previous employer's plan through the Consolidated Omnibus Budget Reconciliation Act (COBRA) at your own expense, for up to 18 months. Before making a switch, make sure the new plan has the maternity coverage you want. HIPAA doesn't require an employer to provide maternity care.
Governmental and Self-Pay Options
If neither you nor your spouse have insurance and you are pregnant, you may be able to sign on with government- and state-endorsed health care programs such as Medicaid, or MediCal in California, which can provide medical help for families who meet certain income requirements. If you make too much to be on Medicaid, you still have options such as Access for Infants and Mothers (AIM), which foots your pregnancy-related bills based on income. You then pay them back through a variety of payment plans. AmeriPlan is a health-care discount program that discounts bills by 50 percent or more -- and you don't pay deductibles.
Maternity Options After Obamacare
With the advent of the Patient Protection and Affordable Care Act (commonly called "Obamacare," as it's a bill that President Obama signed into law), if you are pregnant and uninsured, you may have more options than just Medicaid. As of January 1, 2014, both individual and small group health insurance markets will have to provide coverage for at least 10 categories of care, including maternity and newborn care, which are considered essential benefits. It is possible that an insurance company may choose categories other than maternity coverage for a plan, but state-run health exchanges also use the essential benefit standard, so you should see more opportunities to grab onto inclusive coverage.
- American Pregnancy Association: Health Insurance for Pregnant Women
- Childbirth Connection: Finances and Insurance
- Health Guidance: Pregnant Without Health Insurance?
- EC Health Insurance: Maternity & Health Care Reform
- Insure: Ask the Health Insurance Expert
- Insure: Pregnancy Complicates Health Insurance Options
- Jupiterimages/Creatas/Getty Images
- How to Be Covered Under Health Insurance When Changing Jobs
- Copay vs. No Copay
- Definition of Out-of-Pocket Maximum & Deductible
- Tertiary Insurance Definition
- Preexisting Medical Problems and Health Insurance Plans
- HRA Vs. OAP Insurance
- Why Would You Want to Pay for Your Own Health Insurance?
- Insurance Rules on Coordination of Benefits