The Affordable Care Act promises to greatly improve life for pregnant women. Before 2014, a pregnant woman had no chance of buying an individual health insurance plan, and employers were not obligated to include maternity coverage in group health policies.
Beginning in 2014, new individual health insurance plans and employer-sponsored plans cannot refuse you coverage or charge you higher premiums for being pregnant or having other pre-existing conditions.
If you’re pregnant and uninsured, here are some options.
An individual health plan
Under Obamacare laws, health plans must cover your pre-existing conditions, including pregnancy. In addition, health plans sold through state “marketplaces” (aka exchanges) must cover 10 “essential benefits,” and that list includes maternity and newborn care. State marketplaces can be accessed through the Healthcare.gov website.
After the baby is born, you’ll need to buy him or her their own health insurance plan.
The COBRA option
Say you’re pregnant and have group health insurance and then switch jobs. Say your new group health plan has a one-month eligibility period for all new employees before it begins. The new health plan isn’t required to cover your pregnancy until the plan takes effect. While that might not be a problem if you’re early in your pregnancy and you don’t mind paying for a prenatal visit or two out of your own pocket, it could be trouble if you’re in your eighth or ninth month and have no coverage, even temporarily.
Is there anything you can do to bridge the gap between group plans? Yes, you can enroll in your former employer’s COBRA plan to cover any interim period between health plans. Know your COBRA rights. However, employers aren’t required by federal law to offer COBRA unless they have at least 20 employees. And you’ll also wind up paying more in premiums: up to 102 percent of the full premium because of administrative fees. Some states have so-called “mini-COBRA” laws that apply to small employers.
Medicaid is another option, but only if you meet the low-income requirements.
Some women might also qualify for WIC — the Special Supplemental Nutrition Program for Women, Infants, and Children run by the federal government. It provides nutrition counseling and access to health care services to low-income women who are pregnant, breastfeeding, and non-breastfeeding postpartum, and to infants and children up to age 5 who are at nutritional risk. To qualify, women must meet income guidelines, a state residency requirement, be individually assessed as a “nutritional risk” by a health professional, or already qualify for certain other low-income programs, such as Medicaid. For more information, visit WIC online or call your state insurance department.
Planning is vital to ensure coverage
If you’re planning to become pregnant, make sure you have health insurance first. If you’re pregnant and thinking about switching jobs, be aware that you might have to go a month or two without insurance, and make sure your next health plan covers pregnancy. Check with the company’s employee benefits administrator to find out.
Also, if you haven’t already studied your employer’s policy regarding pregnancy leave and other pregnancy-related benefits, now is the time to do so. Here are the basics of pregnancy leave.
It’s illegal for a potential employer to ask a woman in a job interview about her family plans, but obviously if you ask pointed questions about maternity coverage you’ll give yourself away. Still, you could ask for a copy of the company’s benefits handbook and read up on maternity coverage. (Just make sure the handbook contains the most recent plan information available.)
Unmarried pregnant women take note: Despite the movement afoot in some communities and businesses to offer coverage to “domestic partners,” chances are you won’t be added to your boyfriend’s group health plan simply because you’re having his baby; there’s no legal requirement to do so, and it’s at the discretion of the employer.
Once the baby is born, however, the unmarried father should be able to easily add the baby to his group health plan, although he might have to own up to his paternity in writing first. And a woman with individual health coverage should have little problem adding her baby to her plan — but the premiums will increase.