Health Insurance During Pregnancy and for New Babies

For many women, pregnancy and childbirth are among the most expensive health care costs that they will face in their lifetimes, and without adequate health insurance coverage, they can end up with tens of thousands of medical debt. Fortunately, if you are pregnant and you do not have health insurance, there may be ways that you can get the coverage that you need.

Pregnancy and the Affordable Care Act

The Affordable Care Act guarantees 10 essential health benefits to individuals with major medical insurance. Among these benefits is maternity care, meaning that all health insurance plans purchased through employers or on the Marketplace cover medical care during pregnancy, childbirth and postnatal care.

Prior to ACA, many plans in the individual marketplace did not cover pregnancy for new enrollees. Also, health insurance company’s would deny coverage to women who were already pregnant by a method called “underwriting”. If a woman became pregnant, many plans did not cover anything maternity. Underwriting is now mostly a thing of the past for health insurance. Underwriting is where a person would look at your height and weight and medications and health pre-existing conditions, and if you were too high of a “risk”, you would be denied insurance coverage. Sometimes they would “exclude” your preexisting medical condition for a year, sometimes for a lifetime, it just depended on the insurance company.

Under Obamacare, pregnancy is no longer considered to be a pre-existing condition. Health insurance companies cannot deny coverage to pregnant women or charge them more for coverage. However, in most states, pregnancy is not a life event that opens a Special Enrollment Period. This means that it does not qualify you to sign up for health insurance or make changes to your policy outside of the yearly Open Enrollment Period. You must do this during “Open Enrollment”.

Please Note: Very Important

The BIRTH of a baby is a Life Event, so you can add the baby to your plan or buy them a plan for themselves, after they are born. But pregnancy is NOT a “life event” to get health coverage.

Getting Health Insurance While Pregnant

Pregnant women may have avenues through which they may be able to sign up for health insurance or receive affordable care.

Medicaid

In Nevada, pregnancy is covered under Medicaid and Nevada Check Up for women and children who meet income guidelines.

Community Health Centers

Community health centers receive federal funding to provide free or low-cost services to area residents. Some community health centers only serve uninsured patients or those who meet income restrictions, while others offer services to everyone regardless of income or health insurance status.

Local Charities

Some charities and religious organizations have free or low-cost clinics that provide free medical care for pregnant women.

Self-Pay Option

Some hospitals may have special programs or sliding fee schedules for uninsured pregnant women who are paying for their care out of pocket. While this is still an expensive risky option compared to having care covered by health insurance, it may help you potentially.

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Health Insurance Options for New Babies

Having a new baby is a very exciting time, but it can also be overwhelming. Those first weeks and months of life bring a lot of surprises, but medical bills should not be one of them. Ensuring that your new baby is covered under your health insurance plan is key for avoiding hefty medical expenses.

Every parents’ hope is for a healthy baby. However, even without complications, your baby’s medical bills can be very high. In fact, a 2016 study shows that in the first year of life, a healthy infant’s medical bills average $4,879. If you do not ensure that your baby has health insurance, then you will have to pay these bills out-of-pocket.

Does My Health Insurance Automatically Cover My Baby?

The good news is that for the first 30 days after a baby’s birth, their medical expenses are covered by the mother’s or father’s health insurance, as an extension of maternity care. However, on day 31, this coverage ends. To avoid a lapse in coverage and potentially end up with exam and vaccination bills, you need to add the baby to your insurance policy.

Most insurance companies will add the baby to your policy back to your baby’s birth if added within the first 30 days. Otherwise, your baby may go a month without coverage if you have not called to have your baby added before the 60th day after the birth of the baby. If you wait more than 60 days to call and add your baby, you will be out of luck, you no longer have a “life event”. You’ll need to wait until the next open enrollment period. Please call us or check with your HR at work for details.