Can You Get Maternity Insurance If Already Pregnant?

Navigating health insurance options during pregnancy is a common concern. While securing new insurance that immediately covers an existing pregnancy can be challenging, various avenues and programs exist to ensure access to necessary care. Understanding these pathways is important for managing prenatal care, childbirth, and postnatal support. This guide explores options for maternity coverage.

Navigating Enrollment Periods for Coverage

Acquiring health insurance follows specific enrollment periods. The annual Open Enrollment Period, from November 1st to January 15th, is the primary time to sign up or change plans. If already pregnant outside this timeframe, immediate enrollment through the standard process is not possible for the current pregnancy. Beyond Open Enrollment, Special Enrollment Periods (SEPs) allow enrollment due to qualifying life events (QLEs), such as losing health coverage, marriage, or moving. Pregnancy itself is not a qualifying life event for an SEP under federal guidelines, meaning it does not trigger a new enrollment window.

However, the birth of a child is a qualifying life event that triggers an SEP, allowing parents to enroll the newborn and themselves within 60 days of birth. Some states have broader rules where pregnancy can be a qualifying life event. To determine SEP eligibility, individuals need to gather specific information and supporting documentation, such as the event date or a marriage certificate.

Government-Assisted Health Programs

Medicaid is a joint federal and state program offering health coverage to low-income individuals and families. Eligibility for pregnant individuals is more lenient, extending to higher income levels based on the Federal Poverty Level, with some states covering incomes up to 200%. The Children’s Health Insurance Program (CHIP) provides prenatal, delivery, and postpartum care to pregnant women with limited incomes who do not qualify for Medicaid. Both Medicaid and CHIP offer year-round enrollment, accepting applications at any time, which benefits pregnant individuals needing immediate care.

To apply for these programs, individuals need to provide proof of income, household size, state residency, and pregnancy verification. If eligible during pregnancy, coverage continues for at least 60 days after birth, with some states extending postpartum coverage for 12 months.

Exploring Other Coverage Avenues

The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows individuals to continue health coverage from a previous employer’s group plan for a limited time after a job loss or other qualifying event. If the original plan included maternity benefits, COBRA continuation coverage will also include those benefits. Individuals are typically responsible for paying the full premium plus an administrative fee, up to 102% of the plan’s cost. COBRA can provide continuity of coverage for up to 18 months, or longer in specific situations.

Securing a new job that offers health benefits presents another pathway to coverage. Employer-sponsored plans are generally required to cover pre-existing conditions, including pregnancy, without additional charges. Federal regulations, like the Affordable Care Act (ACA), limit waiting periods for new employees to a maximum of 90 days before coverage begins. This ensures new employees eventually gain access to their employer’s plan benefits.

Short-term health plans, while offering lower premiums, are generally not suitable for maternity coverage, especially for an existing pregnancy. These plans are not required to adhere to ACA mandates regarding essential health benefits, often exclude pre-existing conditions, and typically do not cover maternity care. Relying on a short-term plan for pregnancy-related medical expenses is often financially unfeasible. Similarly, plans purchased directly from an insurance company outside the Health Insurance Marketplace follow comparable rules. Under the ACA, these plans must also cover maternity care and cannot deny coverage or charge more due to pregnancy.