Insurance For Pregnant Women With No Maternity Coverage

Food For Thought: This article is a continuation of the first article which I published In November last year. I urge you to read that as well. Link is in this paragraph. Pregnancy complicates health insurance options for women who do not have medical coverage. Ideally you should have insurance coverage for pregnancy before you thought of conceiving your child as your options will be limited once you are already pregnant. After pregnancy if you are searching a suitable insurance for pregnant women then the main criteria of differentiation is what are your options between a group health insurance plan and individual health insurance options. If you are seeking affordable maternity insurance coverage under a group health insurance program then your employer sponsored health plan should be covering it. No employer’s group health plan can deny you coverage for being pregnant. What I mean here is under the federal law, HIPPA Act, pregnancy cannot be termed as a pre-existing condition under a group health plan. As far as individual health insurance options for concerned we will discuss below.

Medicaid And State Assisted Programs


Presumptive Eligibility For Pregnant Women With Limited Benefit


If you are a uninsured pregnant women then this program will help you in getting immediate coverage for prenatal care.

Eligibility: This program is exclusively available for low income families. Any women who is pregnant and belongs to a certain level of low income group then she would qualify for Presumptive Eligibility. Consult your doctor on the eligibility criteria. Also remember, presumptive eligibility is a temporary option which does not cover labor and delivery charges. Further details can be obtained by contacting the Presumptive Eligibility support number on 1-800-824-0088.Low income criteria for almost all states is 200% of federal poverty level. Moreover all states must cover women for maternity insurance under Medicaid if the women’s individual income is about $20,000 annually. Many states cover pregnancy under Medicaid and some of them cover pregnancy under Children Health Insurance Program (CHIP)

The map below shows state wise presumptive eligibility updated till January 2013.


Maternity Coverage Will Be Mandatory In 2014

Starting 2014, maternity coverage will be a part of the 10 essential health benefits which will be mandatorily offered by individual and group health plans including the private market through state sponsored health insurance exchanges.


Group Health Insurance Through Your Employer

Check with your employer what are your options in terms of insurance for pregnant women. Group health insurance plans are more comprehensive in nature as compared to individual health insurance options. Employer sponsored group health insurance plans mostly will cover maternity care and have their own advantages as follows:

  • Pregnancy complications which are related to age are not denied as compared to individual health plans.
  • Further complications like hypertension and pregnancy induced gestational diabetes are covered in group health insurance.
  • Miscarriage can be denied in individual health plans. This is not the case with group policies.


Individual Health Insurance Plans And Pregnancy Coverage

Individual health insurance is also known as single payer plans. Many such plans offer additional riders to offer supplemental maternity coverage to cover labor and delivery cost. You have to pay extra for such riders. There are different types of individual health insurance plans which can be checked. It will be very difficult to find affordable maternity insurance options among individual plans however you might be able to get a guaranteed issue policy which cover pregnancy. Having said that, you premium will be high. Another cheaper alternative is to check for the state sponsored high risk pool. Another drawback of individual plans is that pregnancy is considered a preexisting condition and hence the denial rate is high.

So, to summarize your options for insurance when you’re pregnant and without health insurance:

  1. You can apply for Medicaid and get coverage provided you meet the eligibility criteria
  2. If you are well off financially then you can pay for all your treatment and labor charges by paying cash.
  3. Consider buying an individual health insurance plan. This might be a costly alternative among all but will be handy when your baby needs medical attention during childhood.
  4. You may also check for medical discounts plans which are not health insurance policies but under them you can get medical treatment at reduced cost. Check your doctor for more details.

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