You’re pregnant. Congratulations! You’re thinking of names, but have you thought about health insurance for your pregnancy?
Out of Pocket Costs
If you don’t currently have insurance, you may be considering paying for your prenatal care and delivery out of pocket. On average, without insurance prenatal care costs approximately $2000. Labor and delivery without complications costs over $10,000. However, 1 in 3 women deliver via c-section and at least 60% of women have an epidural which can push costs upwards of $30,000! You can absolutely find less expensive options, but should the unexpected arise, you will definitely want health insurance. Additionally, under the ACA women are guaranteed breastfeeding support in the form of breast pumps and lactation counseling.
So what are your best options?
Group Health Insurance
First, you may qualify for insurance if your employer has at least 50 full time employees. Under the ACA, employers with at least 50 FTE must offer affordable health insurance wherein they will pay at least half the premium. This applies to the employee and their dependents but does not necessarily have to apply for spouses.
Pregnancy must be covered under group insurance, so if you are eligible, this is certainly the easiest route. You will likely meet your out of pocket maximum for employer sponsored coverage (although possibly not if you have a HDHP)
Remember, if you have group health insurance and you are laid off, you would still be eligible for COBRA and able to keep your exact same coverage. However, that is usually cost prohibitive under most circumstances.
Marketplace Insurance
It comes as a surprise to many that becoming pregnant does not actually qualify you for a special enrollment period in most states. So, if you do not currently have insurance and become pregnant, you cannot automatically enroll in a marketplace plan.
However, there are several factors which would make you eligible for a special enrollment period. For example:
Loss of coverage- so if you are laid off and lose your coverage, you could choose to enroll in COBRA, but if not, you could choose to enroll in a marketplace plan.
Change in Household Size- If your household size increases through birth, adoption or marriage you would be eligible for a SEP. If your household size decreases due to death or divorce, you would also be eligible.
Change in Location- this is an important one. Let’s see you are expecting and need to move, perhaps to a bigger home. Depending on where you move, you may be eligible for a special enrollment period.
Also, we’re going to talk about Medicaid in a little bit, but remember applying for and being denied Medicaid could make you eligible for a SEP.
In general, marketplace plans can be great for pregnancy.
Other Options:
There are other options as well, for example: Medicaid. Remember that even if your income alone wouldn’t make you eligible for Medicaid, if you are pregnant the criteria can be different. Now although medicaid isn’t really something we can advise on, we highly recommend you contact your local office.
There are also many free and low cost clinics available, but please do not put off accessing prenatal care. Many OB/GYN’s will not take on new patients past 20 weeks and you do not want to be without a doctor that you trust.
Also remember, even if your options are currently limited, the actual birth of a child is a qualifying life event that will make you eligible for a special enrollment period in the marketplace. So, once your baby arrives, you may have more options.
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
