Options If You're Pregnant With No Maternity Insurance

Resources for Affordable Pregnancy Care and Maternity Insurance

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Being pregnant without maternity insurance is really stressful. But, there are resources to help you and your baby get the care you need. Steve Devenport/E+/Getty Images

If you’re pregnant and don’t have health insurance, you probably feel vulnerable and overwhelmed. While individual health insurance plans that include maternity coverage are available through the Affordable Care Act's health insurance exchanges, you can only enroll in those plans during open enrollment.

If you're pregnant during open enrollment, you can sign up for a plan that will be effective in the coming year.

All new plans are required to have maternity benefits under the ACA, and pre-existing conditions—including pregnancy—are no longer an obstacle.

But if you find yourself uninsured and pregnant early in the year, after open enrollment has ended but many months ahead of the start of the next year's open enrollment, certain circumstances will provide you with another chance to enroll. See: " I Missed Obamacare Open Enrollment. What Now?"

Although some pregnant women might be eligible for special enrollment periods due to qualifying events, pregnancy itself is not a qualifying event. But there's an exception in New York. Legislation was enacted in 2015 (effective January 2016) in New York to make pregnancy a qualifying event for plans purchased via the state-run exchange, New York State of Health. That means a pregnant woman in New York can enroll in coverage for the first time, or switch to a different plan once she becomes pregnant.

New York is the only state that has such a provision. In the rest of the country, pregnancy is not a qualifying event.

What follows below are alternative options if you need maternity insurance now, if you're not eligible for insurance through Obamacare, or if you have to wait until the next open enrollment to get an Obamacare plan, but need prenatal care before then.

Local Health Department

Your first stop should be your local Health Department. Many Public Health Departments provide maternity care. Usually, these services are limited to lower-income individuals, but if you don’t meet the income criteria, they can still provide a wealth of information on what other resources are available in your area. Use this tool to locate your local Health Department.

Community Health Center

Community Health Centers provide affordable care to people with limited access to healthcare. While they don’t provide maternity insurance, they do provide comprehensive primary and prenatal care with fees based on your income and ability to pay. Since not all communities have one, check to see if there is a Community Health Center near you.

Medicaid

Medicaid is a government program that provides health insurance to low-income people. States differ about who qualifies as a low-income person. If you qualify, Medicaid’s maternity insurance coverage can be retroactive, covering prenatal care you got even before you applied for Medicaid.

Also, when you qualify, your baby will be covered when it’s born.

Medicaid eligibility levels are higher for pregnant women than they are for other adults, and even in states that haven't expanded Medicaid under the ACA, pregnant women are eligible for Medicaid with incomes above the poverty level (eligibility ranges from 133 percent of the poverty level in Idaho, Louisiana, and Oklahoma, to 375 percent of the poverty level in Iowa).

Medicaid allows enrollment all year long so you're not constrained by an open enrollment period.

Children’s Health Insurance Program

The Children’s Health Insurance Program provides health insurance to uninsured children, but in a few states (Colorado, Missouri, New Jersey, Rhode Island, and Virginia), it also provides coverage to pregnant women. Although it focuses on people who can’t afford health insurance, CHIP programs allow higher incomes than Medicaid does. All five of those states have eligibility thresholds of 200 percent of the poverty level or above for pregnant women to qualify for CHIP. Even if you don’t qualify, your baby might qualify when it is born. Like Medicaid, CHIP allows enrollment all year long.

Hill-Burton Facility

As of November 2016, there are 143 hospitals and health clinics nationwide that are obligated to provide free or low-cost care because they accepted grants or loans under the Hill-Burton Act. Go to the admissions office of one of these facilities and tell them you want to apply for Hill-Burton free or reduced-cost care. You’ll need to meet low-income requirements, but you don’t have to be a US citizen.

The facility is only obligated to spend a limited amount of money each year on Hill-Burton care, so you’ll have to use their services before that year’s money is gone. This covers the hospital’s charges, but not necessarily the doctor’s charges since it isn’t truly maternity insurance; it’s a type of charity care.

Charity Care Organizations

Organizations like Catholic Charities and Lutheran Services offer programs to help women with maternity care. Services vary by location. Basic services include counseling and referrals. But, some locations provide services as extensive as maternity homes that provide free maternity care, postpartum care, parenting classes, and room and board. At the least, they’ll educate you on what other resources are available in your local area.

Young Adult Coverage Under a Parent’s Group Policy

If you’re less than 26 years old and don’t have health insurance from your job, you might qualify for coverage under your parent’s insurance. Even if you’re married or living on your own, you can be included in the health insurance your parent gets from his or her job. You'll likely have to wait until your parent's plan's open enrollment to sign up, but the plan might have an open enrollment that doesn't coincide with the calendar year.

Make sure the plan offers maternity insurance coverage for dependents, as health plans are not required to do so. Dependents must be offered coverage that includes preventive care benefits, including prenatal care. But there's no requirement that plans cover labor and delivery for dependents. 

Planned Parenthood

Planned Parenthood isn’t just for birth control and abortions. Some, but not all, Planned Parenthood locations provide prenatal services. Some, but not all, Planned Parenthood locations base their charges on your income. If your local Planned Parenthood doesn’t provide prenatal care or have a sliding-scale fee structure for self-pay patients, they’ll be able to refer you to other resources within your local community.

Negotiate a Self-Pay Rate

If you end up paying out of pocket, negotiate discount rates in advance and set up payment plans. Frequently, hospitals have a rack rate, a self-pay discount rate, and an even lower charity rate. If you don’t ask about the charity rate, they might not volunteer it. Asking what the charity rate is, as well as how to qualify for it, will help you negotiate because you’ll know the bottom line, even if you don’t qualify for it.

Discount Medical Plan Organization

If negotiating your own self-pay discount scares you, you can work with a Discount Medical Plan Organization. These companies provide pre-negotiated discounts to their members for a monthly fee. This isn’t true maternity insurance since you’re paying the doctor and hospital yourself. But, the discount has already been negotiated for you by the DMPO. Before you enroll, make sure your doctor and hospital participate, as many plans have a severely limited selection of participating health care providers.

Updated by Louise Norris.

Sources:

BillTrack50.com, New York Senate Bill 5972.

Medicaid.gov, Medicaid and CHIP Eligibility Levels as of June 1, 2016.

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