Haris Ashley
Pregnancy is a life-changing event that requires adequate medical support to ensure the health of the mother and the baby. In the past, insurance companies could deny coverage or charge higher premiums to pregnant women, considering pregnancy a pre-existing condition. However, the Affordable Care Act (ACA) has made it easier for pregnant women to obtain insurance. Now, health plans cannot deny coverage or increase premiums based on pregnancy status. This article will explore the options available for short-term medical insurance during pregnancy, including Marketplace plans, Medicaid, and other alternatives.
| Characteristics | Values |
|---|---|
| Short-term insurance coverage for maternity expenses | Short-term insurance does not cover maternity expenses such as delivery if you are already pregnant. Pregnancy is considered a pre-existing condition and is beyond the policy coverage. |
| Short-term insurance coverage for complications during pregnancy | Some short-term insurance plans cover complications of pregnancy that are distinct from any maternity-related routine expenses for the first 26 weeks of pregnancy. |
| Affordable Care Act (ACA) | ACA has made it easier for pregnant women to get insurance to help pay for the medical care they need. Health plans cannot deny coverage or charge more if you are pregnant. |
| Special Enrollment Period | Having a baby qualifies you for a Special Enrollment Period, allowing you to enroll in a Marketplace health plan outside of the Open Enrollment Period. |
| Medicaid and CHIP | If you report your pregnancy, you may be eligible for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). |
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What You'll Learn
Pregnancy is not a pre-existing condition under the ACA
In the past, insurance companies could deny coverage to pregnant women or charge them higher rates. Many health plans considered pregnancy a pre-existing condition. However, the Affordable Care Act (ACA) has changed this. Today, most insurance plans are bound by ACA regulations, which means that insurance companies can no longer deny coverage or charge higher rates to pregnant women or those with prior pregnancies. This applies whether you get insurance through your employer or buy it yourself.
Under the ACA, pregnancy is not considered a pre-existing condition. All ACA-compliant plans cover maternity, and insurance companies cannot increase premiums based on health conditions. This means that health plans cannot charge more for a policy if you are pregnant. They also cannot limit benefits for that condition. Once you have insurance, they cannot refuse to cover treatment for your pre-existing condition.
However, it is important to note that short-term health insurance plans are not required to follow ACA regulations. These plans can deny coverage or charge higher rates if you are pregnant. Grandfathered health plans, which were in existence before 23 March 2010 and have not made significant changes to their benefits and costs, are also not required to cover pre-existing conditions. If you have a grandfathered plan, you may need to wait until the next open enrollment period to switch to a plan with maternity coverage.
If you are pregnant and seeking insurance, you may be eligible for Medicaid or the Children's Health Insurance Program (CHIP). These programs provide free or low-cost health coverage to pregnant women, depending on income requirements, which vary by state. You can apply for these programs at any point during the year.
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Short-term insurance plans do not cover maternity expenses
Before the Affordable Care Act (ACA), only a few insurance plans automatically provided maternity coverage. Now, all Marketplace plans must cover pre-existing conditions that were present before coverage started. Pregnancy is not considered a pre-existing condition, so you cannot be denied coverage or charged a higher premium because of it. Your pregnancy and prenatal coverage will start on the first day of coverage.
If you already have health insurance, it is important to know if your plan is grandfathered or not. Grandfathered insurance plans are those that were in place on March 23, 2010, and have not been significantly altered to affect consumer benefits or the cost of insurance to consumers. Individual grandfathered plans that you purchase yourself are not obliged to provide maternity and childbirth benefits. If your plan is grandfathered, contact your insurance company to determine what coverage you have.
If you do not have coverage through the Marketplace or an employer, 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. Many states have broadened their income requirements, so it is worth checking even if you did not qualify previously. You can also apply for these programs at any point during the year.
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Medicaid and CHIP provide free or low-cost coverage for pregnant women
In the past, insurance companies could deny coverage if you applied while pregnant. Today, health plans cannot deny coverage if you are pregnant, whether you get insurance through your employer or buy it yourself.
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, such as prenatal doctor visits, prenatal vitamins, labor and delivery, and checkups and other benefits for the baby after leaving the hospital. These services are provided by health plans.
Eligibility for Medicaid and CHIP is based on income requirements, which vary by state and are different for each program. Some states have broadened their income requirements, so even if you did not qualify previously, you may now be eligible. You can apply for these programs at any point during the year. If you have other health insurance, you are not eligible for the CHIP Perinatal program.
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. Having a baby qualifies you for a Special Enrollment Period, which means that after you have your baby, you can enroll in Marketplace coverage even if it's outside the Open Enrollment Period.
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Marketplace plans cover pre-natal and post-natal care
If you're pregnant, soon to be pregnant, or planning to expand your family through adoption, you can enrol in a Marketplace plan that covers pre-natal and post-natal care. All Marketplace plans cover pregnancy and childbirth, even if your pregnancy begins before your coverage starts. Maternity care and newborn care are essential health benefits, and all qualified health plans meet the Affordable Care Act's requirement for having health coverage, known as "minimum essential coverage".
Marketplace plans cover essential health benefits, follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements under the Affordable Care Act. This includes coverage for medical check-ups and screening tests to help keep both you and your baby healthy during pregnancy.
If you already have Marketplace coverage when your baby is born, you can keep your current plan and add your baby to your coverage. Alternatively, you can create a separate enrolment group for your baby and enrol them in any plan for the remainder of the year. It's important to report their birth to the Marketplace by updating your application as soon as possible, as your coverage options and potential savings may change.
If you have Medicaid coverage when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year. Losing other coverage or having a baby qualifies you for a Special Enrollment Period, allowing you to enrol in a Marketplace plan even if it's outside the Open Enrollment Period.
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Pregnancy grants access to a Special Enrollment Period
Pregnancy does not qualify you for a Special Enrollment Period in most states. However, having a baby does qualify you for a 60-day SEP, during which you can enroll in a Marketplace health plan even outside the Open Enrollment Period. This means that you can shop for insurance and enroll in a plan for yourself and your baby after giving birth, even if you missed the open enrollment period.
If you already have Marketplace coverage when your baby is born, you can keep your current plan and add your baby to your coverage, or create a separate enrollment group for your baby and enroll them in any plan for the remainder of the year. You can also request that your coverage start later by calling the Marketplace Call Center.
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. If you don't have Medicaid but are eligible, your information will be sent to the state agency, and you won't be given the option to keep your Marketplace plan. In this case, you can apply for Marketplace coverage within 60 days after your baby's birth.
In 2016, New York became the first state to establish a pregnancy special enrollment period, and as of 2024, five additional states and the District of Columbia have followed suit. In these states, pregnant people can access health coverage during their pregnancy without having to wait until the baby is born.
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Frequently asked questions
No, short-term health insurance plans do not cover maternity expenses such as delivery if you are already pregnant. However, you can get insurance through the Marketplace or your employer, and health plans can no longer deny you coverage or charge you more if you are pregnant.
Insurance plans in the Marketplace and Medicaid cover prenatal and postnatal visits to the doctor, lab tests, medications, preventive screenings, inpatient services, and more.
If you are already insured, you should contact your insurance company to determine what coverage you have. If you are uninsured, you can apply for Medicaid and/or CHIP, or apply for insurance through the Marketplace.
The cost of insurance while pregnant depends on your income and household size. You may qualify for a special open enrollment period and financial help from the government if you have a low income.
