Pregnancy and your Health Insurance

If you are pregnant or thinking of becoming pregnant, you may have already begun thinking about how to pay for the healthcare you will need during your pregnancy.  With the estimated costs of delivery alone ranging between $6,000-$8,000 for a normal pregnancy and even more in cases of high-risk pregnancy, it is only prudent to begin planning for how to pay for healthcare costs as early as possible, and not to let the anxiety and worry of the financial burdens ruin what should be a joyous time.

Group Health Plans

Under the Health Insurance Portability and Accountability Act (HIPAA), federal law bars group health plans from considering pregnancy a pre-existing condition.  So, for example, if you have changed group health plans during your pregnancy and your new plan covers maternity, your new plan cannot deny your claims related to your pregnancy.  In these cases, federal law requires your group plan to cover your pregnancy whether you are the primary insured or a dependent.

Unfortunately, even with HIPAA you still are not home free, and it is important to remember a few things.  First, federal law only requires your new group plan to cover your pregnancy if it already covers maternity.  If your new group plan does not cover maternity at all, it will not be required to begin covering maternity in order to cover your pregnancy.

Secondly, HIPAA only applies to group plans.  Individual plans are free to consider pregnancies as pre-existing conditions, and because of the costs associated with pregnancy, virtually all do which makes finding individual coverage a very frustrating and expensive proposition if you are already pregnant.  You may not be able to find pregnancy coverage at all, and if you find coverage, you may be required to sit out a waiting period and/or premiums may be cost-prohibitive.

In addition, if you are an unmarried pregnant woman, please note that employers generally are not required to offer coverage to unmarried domestic partners.  You will likely have to find your own health insurance, because most employers do not extend coverage to their employees’ domestic partners.

COBRA

If you are planning to leave a job while you are pregnant, we suggest that you consider COBRA if it is available to you.  Even under HIPAA, if you are joining another group health plan through a new employer, your new employer may require a waiting period of up to 6 months to a year before you are eligible to sign up for their sponsored health plan. By continuing the group coverage that you already have, you eliminate the possibilities of being turned down for coverage or being required to sit out a waiting period while you are pregnant.  In addition, although COBRA coverage may cost more than the same coverage did while you were employed, it is almost inevitably cheaper than if you were to seek coverage while pregnant on your own.  

Not all employers are required to offer COBRA.  For more information on COBRA and the current government subsidy,  see our article on COBRA basics: “COBRA – What you Need to Know.”

Individual Insurance

If you are already pregnant and don’t already have insurance, unfortunately finding affordable health insurance which will cover your pregnancy will be nearly impossible. Insurance companies will already know that you have a condition which will require treatment and claim payments.  Under certain federal and state laws, insurance companies may be required to offer you a plan under “guaranteed issue” laws, but in almost all cases, the premiums charged will be exorbitant since insurance companies will consider the expected expenses into your premiums.  A better option may to try find affordable coverage as part of a state high risk pool.   

Government Assistance

If you meet the low-income requirements, you may qualify for Medicaid.  For more information on Medicaid, our article on Medicaid.

If you are a woman with low income, you may also qualify for the federal Special Supplemental Nutrition Program for Women, Infants and Children (WIC).  It provides nutrition counseling and access to health care services to low-income women who are pregnant, breastfeeding, and non-breastfeeding postpartum, and to infants and children up to age 5 who are at nutritional risk.

To qualify for WIC assistance, you must meet income guidelines, a state residency requirement, be individually assessed as a "nutritional risk" by a health professional, or already qualify for certain other low-income programs, such as Medicaid.  For more information on WIC, please see http://www.fns.usda.gov/wic/aboutwic/howwichelps.htm.