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Health Insurance For Pregnant Women


Health Insurance for Pregnant Women: Will I Be Able To Get It?

The short answer is perhaps. There are three insurance options you might qualify for, two state assistance programs, local resources, and some low-cost birthing options. But it’s tricky to get California pregnancy insurance when you are already pregnant unless you apply for coverage during an open enrollment period.

If there are complications the medical costs climb at an exponential rate (premature babies can use over $30,000 – $85,000 in medical costs in the first weeks of life, and more than 1 in 10 California babies are premature or underweight). Because of these costs and risks, Health insurance companies will decline applications from women that are pregnant unless they have a qualifying life event, or applying during open enrollment, so other strategies will have to be explored in order to get maternity coverage.

Join a Group Health Insurance Plan to get Insurance For Pregnant Women

Insurance option number one is to join your company’s health insurance plan, Pregnant without Insuranceor the group health insurance plan at your spouse’s company. Most group health plans offer maternity coverage, and are guaranteed issue – meaning that you can’t be declined when you apply to join the group plan, even if you are already pregnant.

The difficulty with this option is that company plans have open enrollment windows during which you can join the plan. If your pregnancy is outside the window, you may have to wait for the next annual window before you can enroll in the plan. Ask your company if a special enrollment period can be set up.

If not, and the normal open enrollment happens within 6 months of the time you become pregnant, this option can work. However, you will have to pay the initial costs of prenatal care until you are on the company insurance plan.

Getting Health Insurance With Maternity Coverage During Open Enrollment

Health Insurance option number two applies to women that are enrolling for coverage during the annual open enrollment period for Obamacare plans. This enrollment period happens each year in the fall. Typically starting in November and lasting until the end of the year.

During this open enrollment period, you can not be turned down for coverage. Therefore, pick the plan that will allow you to see the doctor you want, deliver at the hospital you want, and minimize your out of pocket expenses.

Click here to see the top maternity plans in each region of California.

Get Health Insurance For Pregnant Women Through A Qualifying Life Event

The third health insurance option is to sign up for coverage using a Qualifying Life Event. These qualifying life events are typically significant changes such as:

  • Losing health insurance when you leave a job
  • Moving to a new state or location
  • Getting married, divorced, or widowed
  • Having a baby or adopting a child

There are many other options as well. For a complete list of qualifying events click here.

Unfortunately, at this time, becoming pregnant is NOT a qualifying event.

If you find out you are pregnant and don’t have health insurance, you will have to wait for the next open enrollment period, or look into the next several options.


The PCIP option no longer applies after 2013

Medi-Cal Provides Insurance For Pregnant Women

Medi-cal is the California version of the Federal Medicaid program. Medi-Cal should be your starting point if you can not obtain regular health insurance using the options above.

If you meet the income limits for Medi-cal you can apply for this no-cost health plan that provides benefits for pregnant women. Medi-cal is intended to provide coverage for low income families and women that are below the federal poverty level.

If your income is above the Medi-cal qualification levels, then you should apply for the AIM (Aid for Infants and Mothers) program.

AIM Provides Health Insurance For Pregnant Women

The AIM program is provided for middle-income families that don’t have maternity health insurance, or have a health plan with a deductible or co-payment greater than $500.

AIM is a low-cost program that you may qualify for if your income is too high to meet the Medi-Cal limits. For example, a single mother’s monthly household income can be between $2,453 to $3,679 and qualify for AIM (there is a table with income ranges for families of difference sizes at http://www.aim.ca.gov/Costs/Income_Guidelines.aspx).

One caveat for the AIM program is that it’s funding is provided by the State of California. Although money is usually available, if the program fully utilizes its funds, then no additional mothers will be enrolled.

For additional information about AIM and Medi-cal see the following websites:

http://www.aim.ca.gov/AIM_Program/ Information about the AIM program

http://www.dhcs.ca.gov/services/medi-cal/Pages/default.aspx Information about Medi-cal

http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_women.aspx Information about the Presumptive Eligibility program to gain access to Medi-cal quickly

Local or County Resources For Pregnant Women

If not of the previous options works, then look into the local resources that may be available in your county. A great way to find this information is through the free-clinics in your town.

These clinics will know about the local resources that may be available to you. Call them and ask.

Low-Cost Prenatal and Delivery Options

If you find that you have to pay the full costs with no assistance, then you should check out these low-cost providers. Most of these providers do not accept maternity insurance plans.

These options are:

  • Midwife – certified midwives provide a full range of prenatal and delivery services outside a medical/hospital environment (see our interview with a midwife for more details).
  • Birthing Centers – these typically have a licensed Ob/Gyn oversee the nurses that handle each delivery

I have seen pricing for these types of birthing options with costs in $4,000 to $5,000 range in San Diego county. Look for local providers where you live, and ask them about pricing upfront.


Health Insurance For Pregnant Women – Take The First Step

Health Insurance For Pregnant WomenThe most recent March of Dines PeriStats data shows that 22.3% of women between the ages of 18-45 are uninsured, and that number increased over 12% from 2007 to 2009. Therefore, being pregnant without health insurance is not a rare situation, and has in fact become more commonplace. If you are a woman who is pregnant, no insurance coverage means that the full cost of the prenatal care and delivery costs will be billed to you, and those costs are $12,000 to $20,000, based on what part of the country you live in and the type of delivery you have. To prevent having to pay these costs, finding health insurance for pregnant women is important.

So go ahead and take the first step to determine which plan is right for you. Call your lcoal Medi-Cal office today, then contact the AIM program, and finally, signup for the SPF newsletter and we’ll help you get enrolled in the right plan during the next open enrollment period.


Frequently Asked Questions about Health Insurance For Pregnant Women

1. How do I know if I can qualify for Medicaid?

The easiest way to determine that is to call your local Medi-Cal office. The rules regarding what counts towards your total income and what is excluded are too numerous to cover here. The local people in the Medic-Cal offices can assist you in determining what your Medic-Cal income is.
Click here To find the nearest county Medi-cal office to you.

2. Are Discount Maternity Plans Worthwhile?

There is only 1 discount plan left for pregnant women (AmeriPlan). The other discount plan, Maternity Card, offered by Affordable HealthCare Options, (AHCO), has gone out of business after losing a court case in Texas for not providing any benefit to the subscribers.

The discount card companies say they can save 50% off the retail cost of medical services. That would be great since the regular cost of having a baby can be over $20,000.

AmeriPlan has a network of Doctors that will accept their discount plan, so you should check with your physician to make sure they are part of the network before you sign up. AmeriPlan uses a network of physicians from “BeechStreet”, and their own contracted physicians. I found only 6 Ob/Gyn’s in San Diego county that would accept the AmeriPlan card.

Last I heard this AmeriPlan cost $39.95/mo, so is it worth it? I can’t really say since there is no proof of actual savings….yet.

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