Health Insurance Coverage Options for Pregnant Women

individual health insurance plan

Before the year 2014, there was no chance for pregnant women to buy an individual health insurance plan, and even employers were not obligated to include maternity coverage in their group health plans. However, with the Affordable Care Act, the lives of pregnant women greatly improved. Right from the start of the year 2014, new individual health plans and employer-sponsored plans were not allowed to refuse coverage or charge higher premiums from pregnant women. Currently, women have the following coverage options during their pregnancy.

An Individual Health Plan

As per the Affordable Care Act, health plans are required to cover pre-existing conditions that also include pregnancy. Besides, health plans sold through state marketplace exchanges are required to cover ten essential benefits that also include maternity and newborn care. After the birth of the baby, a new health plan will be required for her/him.

The COBRA option

If a woman is pregnant and having a group health insurance plan, and then she switches her job and her new health plan has a one-month eligibility period for new employees before the start of the coverage. In that case, the new health plan will not cover the pregnancy benefits until the plan takes effect. Though, that might not be a problem for a woman who is early in her pregnancy because she won’t mind paying for a one or two prenatal visit. However, a woman in her eighth or ninth month pregnancy might be in trouble. Thus, to bridge the gap between the two group plans, she can enroll in her former employer’s COBRA plan to obtain coverage for the interim period. As per federal laws, employers having less than 20 employees are not required to offer COBRA. Employers having at least 20 employees can offer COBRA and women availing coverage through COBRA will require to pay more in premiums, which is 102% of the full premium amount due to the inclusion of administrative fees.

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Government Health Plan Options 

Some of the government designed health plans options for pregnant women are: 

  • Pregnant women can opt for government Medicaid plan but only in the case if they meet the low-income requirements.
  • Pregnant women may qualify for the Special Supplemental Nutrition Program for Women, Infants, and Children run by the federal government. This government program provides nutrition counseling and health care services access to pregnant women, and to infants and children up to 5 years who are at nutritional risk. To qualify for this plan, women should meet income guidelines, meet the state residency requirement, should be assessed by health professionals as a nutritional risk, and should have qualified for other low-income programs like Medicaid.

Planning is Vital to Ensure Coverage

Women who are pregnant or planning to become pregnant need to plan out their coverage options so that they don’t remain without any coverage for a long period. Women who are planning to become pregnant should first have health insurance. Women who are pregnant and thinking of switching jobs should plan in a manner that they can manage to remain uninsured for a month or two. Such women should also make sure that their new employer provides health coverage that includes pregnancy benefits. To find out about the pregnancy benefits women can check it with the company’s employee benefits administrator. Women should know in advance about their new employer’s policy regarding pregnancy-related benefits and leaves.

  • Pregnant women before joining a new company should ask for a copy of the company’s benefits handbook to know about the maternity coverage.
  • An unmarried pregnant woman should know that there are chances that she won’t be added to their boyfriend’s group health plan simply because she is having his baby. Employers are not liable to provide coverage to the pregnant partner of their employees, and it is completely at their discretion.
  • After the birth of the baby, a woman having individual health coverage has little problem in adding her baby to her plan and her premium will increase. However, an unmarried father can easily add the baby to his group health plan after owning his paternity in writing first.
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