Pregnant and No Pregnancy Health Insurance: Now what?

One of the pressures faced by pregnant women anywhere in the world today, especially in the United States where healthcare system is complex, is the lack of health insurance with maternity coverage during pregnancy. Ideally, pregnant women should have health insurance coverage including maternity benefits long before the baby is conceived. Under these circumstances, one is assured of enjoying the maternity benefits that come with the health insurance plan availed  from doctor’s visit to nutritious supplemental needs to child birth up to postnatal care. If the correct health insurance plan is selected, there is no need for too much worrying on the financial implications of one’s pregnancy.

Pregnant but without Health Insurance

Certain complications on health insurance options are caused by a woman’s pregnancy. Aside from the fact that pregnancy entails costly medical services (which often times affect the insurance provider’s claims exposure), there are federal laws that prohibit insurance providers from including pregnancy in the list of preexisting conditions. This means that insurance providers are to honor and respect the maternity benefits specified in the health insurance plan even if the pregnant woman changes health plans while pregnant. Insurers cannot deny the pregnancy claims specified in the health insurance plan.

So if one becomes pregnant at a time when no health insurance is availed yet, what options can the pregnant woman take?  Let’s look at the available options under the scenarios below :

  • if the pregnant woman without any health insurance plan at the time of pregnancy,  happens to land a new job which provides for a health insurance, the new health insurance will not have to take effect and instead sit out a waiting period. In this case the pregnant woman has to shell out some money to pay for her pregnancy expenses.
  • if the pregnant woman has a group health insurance plan at the time of pregnancy and change jobs with the new job giving a new group health insurance plan which has a one month eligibility period, the insurance provider is not compelled to cover the pregnancy until the plan is in full effect, meaning after the one month waiting period. Again in this case, the early stages of pregnancy will be paid from personal fund until after the waiting period is over. This is a protection provided for by HIPAA to employees switching jobs.

Chances are, the pregnant woman may not be able to comply with any of the above options for lack of financial preparedness. What happens to a low-income pregnant woman  who has not planned on getting pregnant but did, has no insurance and cannot afford to have one? Can the government offer some assistance to her in terms of medical benefits?

The answer is yes, fortunately. The government has allocated some funds for each state to make sure that uninsured pregnant women will be looked after in terms of their pregnancy and medical needs. About one third of the 13% uninsured pregnant women in the US are eligible for state-funded health insurance programs. We’ve heard about Medicaid which is available in all states. There’s also WIC (Women, Infant and Children). Medi-Cal is California-based government-funded insurance program for uninsured pregnant women.

Additionally, uninsured pregnant women may seek assistance from various organizations like American Pregnancy Association, Ameri-Plan, etc. These organizations are created with one common goal – and that is to offer healthcare coverage for uninsured pregnant women. Eligibility requirements and criteria will vary from one state or organization to another. But the important thing is, the stressed-out pregnant woman will no longer be that much worried about her condition and the expenses that go with it. The financial stress is somehow lifted and there will be time now to enjoy the pregnancy.

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