Haris Ashley
If you are pregnant and do not have insurance, you have several options for low-cost or free maternity care. You can apply for Medicaid, a federal program administered at the state level, which provides coverage for low-income individuals, including pregnant women. You can also apply for the Children's Health Insurance Program (CHIP), which offers limited coverage during pregnancy and two postpartum visits within 60 days of the end of the pregnancy for those who do not qualify for Medicaid and are uninsured. If you already have health insurance, you may be able to add pregnancy coverage during the Open Enrollment Period, which typically starts on November 1st. Pregnancy is not considered a pre-existing condition, so you cannot be denied coverage or charged a higher premium due to your pregnancy.
| Characteristics | Values |
|---|---|
| Pregnancy as a pre-existing condition | Pregnancy is considered a pre-existing condition. Before the Affordable Care Act, insurers either denied coverage or charged pregnant women more. |
| Marketplace plans | All Marketplace plans must cover pre-existing conditions. |
| Coverage for pregnancy | Pregnancy coverage is much more accessible now. |
| Medicaid | Medicaid is a federal program administered at the state level that provides medical coverage for low-income individuals, including pregnant women. Eligibility is based on income and household size. |
| CHIP | CHIP (Children's Health Insurance Program) provides free or low-cost health coverage to children and pregnant women. |
| Special Enrollment Period | Pregnancy does not qualify for a Special Enrollment Period. However, giving birth does. |
| Open Enrollment Period | Pregnant women can get health insurance during the Open Enrollment Period, which usually starts on November 1. |
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What You'll Learn
Pregnancy is not a pre-existing condition
Pregnancy is not considered a pre-existing medical condition by insurers. This means that, in most cases, you are not obliged to disclose your pregnancy when applying for insurance cover. Travel insurance, for example, will cover you for complications associated with pregnancy and childbirth, but not for routine treatments or a normal birth.
If you are planning to travel during your pregnancy, you can obtain travel insurance that covers you in the same way as standard travel insurance, including medical expenses, medical repatriation, personal liability, lost and stolen luggage, and flight cancellation. However, it is important to note that there may be some time restrictions on the coverage provided. For example, you may only be covered for complications associated with premature birth within the first 32 weeks of your pregnancy. Additionally, your policy is unlikely to cover the cost of a routine birth if you give birth overseas. Therefore, it is crucial to carefully read the policy booklet of your chosen insurer to understand any conditions or exclusions.
In the context of health insurance, if you are already enrolled in a Marketplace plan and become pregnant, you can choose to keep your current coverage and update your application after giving birth to add your baby to the plan. Alternatively, you can report your pregnancy, which may make you eligible for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). However, if you choose to report your pregnancy, you will no longer have the option to keep your Marketplace plan. It is worth noting that losing other coverage or giving birth to a child qualifies you for a Special Enrollment Period, allowing you to enroll in a Marketplace health plan outside of the typical Open Enrollment Period.
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Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families, children, pregnant women, the elderly, and people with disabilities.
Medicaid for Pregnant Women includes the full array of Medicaid services, while CHIP Perinatal provides limited coverage during pregnancy and two postpartum visits within 60 days of the end of the pregnancy for women who can't get Medicaid and don't have health insurance. To qualify for Medicaid for Pregnant Women or CHIP Perinatal, you must be a resident of a state that offers these programs, and you must be a U.S. citizen or qualified non-citizen. Your income will also be considered, as these programs are designed for those with low incomes.
If you are found eligible for Medicaid during your pregnancy, you’ll be covered for at least 60 days after you give birth, depending on your state. Some states offer coverage for a full 12 months after you give birth. When your state’s coverage period ends, you may no longer qualify. Your state will notify you if your coverage is ending. If your coverage will end, you can apply and enroll in a Marketplace plan. If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year.
You can apply for or re-enroll in Medicaid or CHIP at any time of the year. If it looks like anyone in your household qualifies for Medicaid or CHIP, your information will be sent to your state agency, and they will contact you about enrollment.
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Health Insurance Marketplace
If you are pregnant and don't have insurance, you can't buy coverage through the marketplace unless you have another qualifying life event. However, there are other ways to get insurance during pregnancy.
Firstly, if you already have a Marketplace plan when your baby is born, you can either keep your current plan and add your baby to your coverage or create a separate enrollment group for your baby and enrol them in any plan for the remainder of the year.
Secondly, if you don't have Marketplace coverage, you can apply for Medicaid and/or CHIP to cover maternity and childbirth health benefits. Eligibility is based on income requirements, which vary by state and are different for Medicaid and CHIP. You can also apply for these programs at any point during the year.
Thirdly, if you or your partner have access to employer-sponsored health insurance, check if the plan covers pregnancy and maternity care. You may need to enrol or make changes during the annual open enrolment period or within a specific window after experiencing a qualifying life event, such as getting married or becoming pregnant.
Finally, you can choose to pay out-of-pocket for pregnancy-related expenses. In this case, inform your provider that you'll be paying out of pocket and try to negotiate lower costs.
It's important to note that all Marketplace plans must cover maternity care as an essential health benefit. They should cover all medical care related to pregnancy, childbirth, and after the baby is born. This includes outpatient services, inpatient services, and screenings.
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Community health centres
If you are already pregnant and are looking to get medical insurance, there are a few options available to you. Firstly, it is important to note that in most cases, you can only enroll during an Open Enrollment period, typically from November through mid-January. Once enrolled, your plan will be required to cover maternity services. You may also qualify for a premium tax credit and/or a cost-sharing reduction, depending on your family income and eligibility for employer coverage. After giving birth, you have a special enrollment period of 60 days, during which you can sign up for health insurance and add your baby to your plan.
If you are a resident of Texas, you may be eligible for Medicaid for Pregnant Women or the Children's Health Insurance Program (CHIP) Perinatal program. These programs provide free health coverage during pregnancy and up to 12 months postpartum. CHIP Perinatal offers limited coverage during pregnancy and two postpartum visits within 60 days of the end of the pregnancy for those who do not qualify for Medicaid and do not have insurance. To be eligible for these programs, you must meet certain income requirements.
Community health centers, such as Planned Parenthood, offer low-cost or free prenatal care and can provide information about getting health insurance coverage. They participate in the Children's Health Insurance Program (CHIP), including CHIP Perinatal (CHIP-P). CHIP is designed for families who earn too much to qualify for Texas Medicaid but cannot afford private insurance. CHIP-P provides prenatal care for the unborn children of low-income women who do not qualify for Medicaid. Community also offers STAR +Plus Medicaid in Texas, which provides additional benefits and services not covered under Original Medicare, such as dental, hearing aids, and vision. They can help you navigate your healthcare journey and coordinate the care you need.
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Planned Parenthood
If you don't have insurance, you may still qualify for low- to no-cost services. Planned Parenthood staff can help you understand your options and find high-quality, affordable care. They offer insurance enrollment assistance in some states, with certified navigators to help answer your questions, fill out applications, and assist with renewals.
In Minnesota, you can typically enroll for coverage in the Marketplace between November 1st and January 15th. During this period, you can select a private plan through MNsure if you are uninsured or already have insurance outside of MNsure. Those eligible for Medical Assistance and MinnesotaCare can apply at any time during the year.
If you have Medicaid or Medicaid-managed care, Planned Parenthood can provide various services, including birth control pills, condoms, foams, diaphragms, IUDs, and Depo-Provera. If you are enrolled in a Child Health Plus plan, you must use in-network providers only. If Planned Parenthood is a provider in your plan's network, you can visit them at no charge.
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Frequently asked questions
Yes, you can get medical insurance if you are pregnant. Pregnancy is not considered a pre-existing condition, so you cannot be denied coverage or charged a higher premium due to your pregnancy. You can get insurance through the Health Insurance Marketplace, or you may qualify for Medicaid or the Children's Health Insurance Program (CHIP) if your income is low.
Health insurance should cover all medical care related to pregnancy, childbirth, and after the baby is born. This includes prenatal and postnatal visits to the doctor, lab tests, medications, preventive screenings, inpatient and outpatient services, and tobacco intervention and counseling.
You can get medical insurance if you are pregnant by applying for coverage through the Health Insurance Marketplace or your state's Medicaid or CHIP program. You can also contact your state or a private company to explore other insurance options.
