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Ask the Health Insurance Expert
I am six months pregnant. Can I get health insurance?
You can if you have have access to group coverage through an employer.
Under federal law, a group health plan can't consider pregnancy a pre-existing condition and exclude coverage for prenatal care or delivery if the plan already includes maternity coverage. So if you go from one job to another or switch employer-sponsored plans, your pregnancy would be covered by the new group plan as long as the plan included maternity coverage.
Many states mandate that group plans cover maternity care, but you can't buy an individual health insurance policy that will cover pregnancy and delivery if you are already pregnant. Some states mandate that individual plans offer maternity coverage, but even in those states, you won't qualify for it if you're already pregnant. Insurers will consider your pregnancy a pre-existing condition and exclude prenatal care and delivery from coverage.
The rules change in 2014 under the health care reform law when insurance exchanges--marketplaces for buying health insurance--open for business in every state. Individual and small-group plans sold through exchanges must include pregnancy and newborn care, along with other essential benefits, and insurers will not be allowed to deny coverage or charge inflated premiums for people with pre-existing conditions, including pregnancy.
Health insurance options during pregnancy
Until then, one option might be the new Pre-Existing Condition Insurance Plan, which was created under the Affordable Care Act and is available in every state. To qualify, you must be a U.S. citizen or legal resident, have been denied health insurance because of a pre-existing condition and uninsured for the previous six months.
Some states also offer additional programs for those who can't qualify for health insurance. Check with your state's insurance department to see what is available. Medicaid and WIC--the Special Supplemental Nutrition Program for Women, Infants, and Children run by the federal government--might also be options if you meet low-income guidelines.
For more, see pregnancy complicates health insurance options.