Can I Get Health Insurance If I Am Already Pregnant?

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No doubt about it, having insurance can ease some of the burdens of pregnancy. According to the American Pregnancy Association, delivering a baby costs more than $6,000. Prenatal (before birth) care, including doctor visits and tests, adds to the expense. Not only does health insurance cover most costs, it can help women obtain needed care and services. Even if you’re already pregnant, you may still be able to obtain health insurance, depending on your circumstances.

Significance

According to the American Pregnancy Association, about 13 percent of pregnant women don’t have health insurance. The Institute of Medicine reports that nearly one-fifth of uninsured pregnant women have to go without important medical care. Lack of proper care has been linked to premature births, low birth weight and a higher risk of developmental disabilities.

Benefits

Health-insurance benefits vary, but most plans will cover doctor visits, laboratory tests, ultrasounds and similar medical tests. Many insurance providers offer classes and programs for pregnant women, helping to ensure that enrollees receive quality care and preparation for parenting.

Misconceptions

A prevalent belief remains that insurance companies refuse to extend benefits to pregnant women. In fact, the Health Insurance Portability and Accountability Act (HIPAA) prohibits group health plans from treating pregnancy as a pre-existing condition. A pregnant woman who already has insurance can switch jobs and join a new health plan. The new health plan must provide coverage for pregnancy services.

Considerations

While group health plans (offered by employers and some associations) must provide coverage, HIPAA does not apply to health plans sold directly to individuals. These plans may treat pregnancy as a pre-existing condition, although some may still provide coverage. In addition, even employer-sponsored insurance may have a waiting period (often 30 days) before benefits apply.

Cautions

Even women with existing health insurance can find their plans offer minimal or limited coverage for pregnancy care. Check the plan’s certificate of coverage to see if a plan provides adequate coverage.

Solution

Women who cannot obtain or afford traditional health insurance may turn to Medicaid, the government-run health plan for lower-income individuals. Women who do not qualify for Medicaid may be able to get coverage through the State Children’s Health Insurance Program (SCHIP). Rules for SCHIP eligibility vary from state to state. Check with your state’s department of insurance for information.

Alternatives

Women who cannot find insurance coverage may still find some ways to reduce costs and get needed care.
Some for-profit organizations offer discounts on medical services in exchange for a monthly fee. Not insurance plans, these companies may require women to follow strict rules for obtaining care and will not cover all of the costs of pregnancy.
Some areas have midwife services that provide licensed professionals to guide women through pregnancy. These services may reduce the cost of prenatal care and delivery.
Finally, negotiating a payment plan with a local hospital may ease some of the financial burdens of having a baby.

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