Paul Sanchez
Pregnancy is an expensive and life-changing event, and it is crucial to have financial coverage for maternity care. While a regular health insurance plan may not cover maternity expenses, specialized maternity insurance plans are available as standalone policies or add-ons to existing cover. In the US, the Affordable Care Act made it easier for pregnant women to get insurance, and health plans can no longer deny coverage or charge higher premiums due to pregnancy. Depending on income and state, Medicaid and CHIP are popular options for low-income individuals, and some states offer coverage for a full year after birth.
| Characteristics | Values |
|---|---|
| Can you get medical insurance if you are already pregnant? | Yes, but only during the Open Enrollment Period, which is typically from November through mid-January. |
| Can you get comprehensive maternity coverage if you are already pregnant? | No, there is a waiting period of 9 months to 2 years before you can claim maternity benefits. |
| Can you get hospital coverage if you are already pregnant? | Yes. |
| Can you get Medicaid if you are already pregnant? | Yes, if your income qualifies you. |
| Can you get CHIP if you are already pregnant? | Yes, if you are a Texas resident and don't have health insurance. |
| Can you keep your current Marketplace coverage if you are already pregnant? | Yes, but you must not report your pregnancy to the Marketplace. |
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What You'll Learn
Pregnancy is not a pre-existing condition
In the past, insurance companies could deny coverage if you were pregnant when you applied. Many health plans considered pregnancy a pre-existing condition. However, this is no longer the case. Today, health plans cannot deny you coverage if you are pregnant, whether you are obtaining insurance through your employer or purchasing it yourself. Furthermore, health plans cannot charge you more for a policy simply because you are pregnant. An insurance company cannot increase your premium based on your sex or health condition.
If you are pregnant and uninsured, you can shop for coverage in the health insurance marketplace, also known as an exchange. You can also see if you qualify for Medicaid in your state, as it is offered to pregnant women with low incomes. The amount of money you can earn and still qualify varies by state, but most states offer coverage to pregnant women with incomes up to or over 185% of the federal poverty level. In addition, you may qualify for a premium tax credit and/or a cost-sharing reduction, depending on your family income and eligibility for employer coverage.
If you already have insurance and become pregnant, you do not need to report your pregnancy to the Marketplace. You can keep your current Marketplace coverage and update your application after giving birth to add your baby to the plan. However, 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). If you are found eligible for Medicaid or CHIP, your information will be sent to the state agency, and you will not be able to keep your Marketplace plan.
It is important to note that pregnancy does not qualify you for a Special Enrollment Period to change your insurance plan. However, the birth of a child does qualify, and you can enroll in a Marketplace plan even if it is outside the Open Enrollment Period. Once enrolled, your plan will be required to cover maternity services.
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Medicaid and CHIP are popular options
Medicaid and the Children's Health Insurance Program (CHIP) are popular options for women who are already pregnant and seeking medical insurance coverage. These programs provide free or low-cost health coverage to millions of Americans, including low-income people, families, children, pregnant women, the elderly, and people with disabilities.
Medicaid for Pregnant Women offers free health coverage during pregnancy and up to 12 months postpartum for those who qualify. The amount of money you can earn and still qualify for Medicaid varies by state, but most states offer coverage to pregnant women with incomes up to or over 185% of the federal poverty level. For example, in 2024, this would be roughly $27,861 for an individual. Coverage includes prenatal doctor visits, prenatal vitamins, labor and delivery, and checkups for the baby after leaving the hospital.
CHIP Perinatal provides limited coverage during pregnancy and two postpartum visits within 60 days of the end of the pregnancy for women who do not qualify for Medicaid and do not have health insurance. To be eligible for CHIP Perinatal, you must not have other health insurance coverage.
To qualify for Medicaid and CHIP, your income must fall within a certain range. You can check your eligibility on the official website by entering your household size and state. If you are found eligible, you will be covered for at least 60 days after giving birth, and some states offer coverage for a full 12 months. Your newborn will be automatically enrolled in Medicaid coverage and will remain eligible for at least a year.
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You can get hospital coverage if already pregnant
If you are already pregnant and need health insurance, you have a few options to consider. Firstly, it is important to note that pregnancy alone does not qualify you for a Special Enrollment Period to change or purchase insurance outside of the Open Enrollment Period. The Open Enrollment Period usually starts on November 1st of each year. However, you can still get hospital coverage if you are already pregnant and have a health insurance plan.
One option for coverage is to purchase a specialised maternity insurance plan or add maternity coverage to your existing plan. Maternity insurance typically covers hospitalisation costs, prenatal and postnatal care, diagnostic tests, newborn care, and delivery charges. However, maternity insurance often comes with waiting periods, which can range from 9 months to 2 years, so it is essential to review the policy terms and conditions carefully.
Another option is to apply for Medicaid, a federal program administered at the state level that provides medical coverage for low-income individuals, including pregnant women. Eligibility for Medicaid is based on income and household size, and it offers coverage for pregnancy-related care, including prenatal doctor visits, vitamins, labour and delivery, and checkups for the baby after leaving the hospital. Additionally, some states offer extended coverage for a full year after giving birth.
If you already have Marketplace coverage, you can keep your current plan and add your baby to your coverage after birth. Alternatively, you can create a separate enrollment group for your baby and enrol them in any plan for the remainder of the year. Having a baby qualifies you for a Special Enrollment Period, allowing you to make changes to your insurance plan outside of the Open Enrollment Period.
It is always advisable to carefully review the terms and conditions of any insurance plan you are considering to fully understand the coverage and benefits provided.
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Maternity insurance has waiting periods
In the past, insurance companies could deny coverage if you were pregnant when you applied. Now, health plans cannot deny you coverage if you are pregnant, and they cannot charge you more for a policy because of your pregnancy. However, many policies have waiting periods before maternity benefits can be claimed, leaving individuals vulnerable to out-of-pocket expenses during pregnancy.
Maternity insurance with a waiting period may not cover prenatal care, childbirth, and postnatal expenses. These expenses can pose a significant financial burden on expectant parents. In response, maternity insurance coverage with no waiting period has gained popularity, offering immediate financial support to expecting mothers.
Specialised insurance plans with no waiting period typically offer comprehensive coverage for maternity-related expenses. This includes prenatal consultations, diagnostic tests, hospitalisation for childbirth (including both normal and cesarean deliveries), postnatal care, and newborn baby coverage. By encompassing a wide range of maternity services, these plans provide holistic support to expectant parents throughout the pregnancy journey.
Short-term health insurance plans can provide quick and temporary coverage lasting anywhere from one to twelve months. They can be a temporary solution to help fill gaps in coverage. However, they may not be the best option for maternity insurance, as they are medically underwritten and not required to comply with certain federal market requirements for health insurance.
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You can't change plans outside of Open Enrollment
If you are pregnant and seeking medical insurance, you may be able to obtain coverage through your employer or your partner's employer. You can also shop for coverage in the health insurance marketplace, which is also called an exchange. You may also qualify for Medicaid if your income is low enough. All qualified health plans meet the Affordable Care Act requirement for having health coverage, known as "minimum essential coverage".
Outside of the Open Enrollment Period, you can only change plans if you qualify for a Special Enrollment Period. Special Enrollment is a period of time outside of Open Enrollment when you can enroll in or change Marketplace plans due to a significant life event or a change in income. Qualifying life events include losing health coverage, moving, getting married, having a baby, or adopting a child. If you qualify for a Special Enrollment Period, you may be restricted to choosing a plan from your current plan category. For example, if you are enrolled in a Silver health plan and lose your extra savings, you will qualify for a Special Enrollment Period, but you will only be able to choose a new plan from the Silver category.
If you are pregnant and do not have health insurance, you may only enroll during an Open Enrollment period, which is 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.
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. The ability to select any plan only applies to your baby; you are generally not allowed to change plans until the Open Enrollment Period.
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Frequently asked questions
Yes, you can get medical insurance if you're already pregnant. However, you may only enroll during an Open Enrollment period, which is typically from November through mid-January.
Maternity insurance covers hospitalization costs, pre- and postnatal care, pregnancy-related diagnostic tests, newborn care, congenital disabilities or complications, and delivery charges.
You may qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). Medicaid is a federal program administered at the state level that provides medical coverage for low-income individuals, including pregnant women.
There is a waiting period for claiming maternity benefits, which can range from 9 months to 2 years depending on the policy.
