Can You Get Insurance While Pregnant?

Individuals can obtain health insurance coverage while pregnant through various avenues, including Special Enrollment Periods, government programs, or employer-sponsored plans. Understanding these options helps ensure comprehensive care throughout pregnancy and beyond.

Accessing Coverage Through a Special Enrollment Period

Pregnancy can initiate a Special Enrollment Period (SEP), allowing individuals to enroll in or change health insurance plans outside the standard Open Enrollment Period. While pregnancy itself does not always trigger an SEP across all states and the federal marketplace, the birth of a child is consistently recognized as a qualifying life event (QLE) for an SEP. Upon the birth of a child, individuals typically have a 60-day window to report the QLE and make changes to their health coverage. This period allows for enrollment through the Health Insurance Marketplace, accessible via healthcare.gov, or through state-specific exchanges. Plans available through the Marketplace are mandated to cover essential health benefits, including comprehensive maternity and newborn care, ensuring access to necessary services during and after pregnancy.

Exploring Other Coverage Avenues

Individuals seeking health insurance while pregnant have additional options beyond Special Enrollment Periods on the Marketplace. Employer-sponsored health plans commonly cover maternity care, and employees can typically add a dependent during their employer’s annual open enrollment period or following a qualifying life event, such as the birth of a child.

Medicaid and the Children’s Health Insurance Program (CHIP) offer another pathway, providing low-cost or free health coverage based on income eligibility. Pregnant individuals are often prioritized for Medicaid eligibility, with income thresholds for pregnant women typically set higher than for other adults. Applications for these programs can be submitted at any time throughout the year, and coverage can often begin immediately upon qualification. Many states cover prenatal, delivery, and postpartum care under these programs, with some even providing coverage for up to one year postpartum.

For those who have recently left a job, the Consolidated Omnibus Budget Reconciliation Act (COBRA) can serve as a temporary continuation of their previous employer’s health coverage. If the former employer’s plan covered pregnancy, COBRA will continue that coverage for a defined period, typically up to 18 months, although it can be more expensive as the individual usually pays the full premium plus an administrative fee. Individuals typically have 60 days to elect COBRA coverage after a qualifying event like job termination.

Navigating the Application Process

Applying for health insurance requires gathering specific information and utilizing the appropriate platforms. Individuals should collect documents proving their identity, such as a U.S. passport or birth certificate, and evidence of income, like pay stubs or tax returns, as these are commonly requested for eligibility determination. Information about household size and any existing health coverage is also necessary for a complete application.

Applications can be submitted through various channels depending on the chosen coverage avenue. For Marketplace plans, the Health Insurance Marketplace website (healthcare.gov) is the primary online portal, while state Medicaid agency websites or local offices handle Medicaid and CHIP applications. Individuals enrolling in employer-sponsored plans or COBRA should consult their employer’s human resources department or benefits administrator. After submission, applicants will typically receive a notice regarding their eligibility, followed by options for plan selection and instructions for premium payment to activate coverage.