Health insurance is particularly important during pregnancy and immediately afterwards, both for women and their babies. These types of care have not always been easily available to women through their insurance plans.
However, in 2014, the Affordable Care Act (ACA) mandated that prenatal care (with no co-pays at doctor visits), labor, delivery and newborn care be included in all healthcare plans, whether or not you get them through the online Marketplace where ACA plans can be purchased. Breastfeeding help is also now mandated.
There are some plans that were in effect as of March 23, 2010 that were “grandfathered” into the new system when the ACA was adopted, so it is important to know if you have one of these, as they may not include maternity coverage.
Some women may find themselves uninsured when they become pregnant. It is important to get health coverage if you do not already have it when your pregnancy is confirmed. Pregnancy is no longer considered a pre-existing condition for purposes of preventing a woman from getting health insurance or from charging her much higher rates because of her pregnancy. Your pregnancy won’t prevent you from getting health coverage. This is because you can no longer be denied health coverage for having a pre-existing condition.
What Does My Health Insurance Cover for Pregnancy?
Although health insurance plans vary widely, and each has different coverages for different things, all health insurance plans should provide insurance for women in the event they become pregnant while on that healthcare plan. You do need to check your policy, though, for specifics.
Your policy may say something specific about maternity coverage, or it may just require that you meet your deductible before the plan pays for larger expenses. Deductibles can be quite high, especially deductibles for a whole family on an insurance plan. And, although some births are straightforward, others involve complications for both mother and baby that can lead to extremely high hospital bills.
Knowing your insurance coverage before heading to the hospital to give birth can save you from a very unpleasant surprise when it is time to take your newborn home (and pay your hospital bill).
What Happens If I Lose or Quit My Job While I’m Pregnant?
Whether you are fired, or you voluntarily leave your job, your insurance through your employer will (immediately or shortly thereafter) be discontinued. You may check to see if your employer provides COBRA coverage, which allows former employees to continue their benefits for a prescribed amount of time, but at a much higher rate. COBRA coverage can be prohibitively expensive.
If you cannot use COBRA, or it is not offered, and you cannot use a spouse’s health insurance, you will want to consider shopping for a new plan. Although normally you can only apply for plans on the ACA’s Healthcare Marketplace during open enrollment periods (usually starting in early November and lasting about six weeks), there are some exceptions.
One of these exceptions is for people who have lost their jobs or otherwise lost their health insurance. They may apply for ACA plans outside of the open enrollment period. Having a baby (although not pregnancy itself-this refers to delivery of a child) is also an exception that allows you to apply for plans outside the open enrollment period.
Depending on your income, you may qualify for Medicaid and your child may qualify for Children’s Health Insurance Plan. You can enroll in these at any point during the year.
What If My Employer Changes My Insurance Plan?
This is less of an issue under the ACA, since the ACA has mandated that all health insurance plans must provide prenatal, labor and birth care (apart from grandfathered plans). If you have insurance through your employer, though, you will still want to check your coverage.
Although you can’t be denied care or kicked off your plan for being pregnant, it is important, just as with any health insurance plan, to know what costs are covered. Your plan’s deductible (for yourself/family) is very important to know.
When My Baby is Born, Will My Baby Get Health Insurance?
Newborn coverage is also mandated by the ACA. Your new baby should be covered under your existing health insurance. They are not automatically added, though! It is very important to contact your insurance company right away after the birth of your baby, in order to have them added to your health insurance plan.
Even in the absence of complications that can cost a lot of money, a newborn needs regular checkups, quite frequently, when they are first born.
Do I Need a Lawyer If I Have Concerns about My Health Insurance While Pregnant?
Although you may not need an attorney to seek health coverage, an experienced personal injury lawyer can help you get the necessary health insurance coverage, if needed, and can also help you seek reimbursement for your costs. They can assist you if you have been denied coverage or experienced any other illegal action.