Insurance Options For Pregnant Women

© Adrienne Manson All rights reserved permission must be granted by the author before any part of this article can be reproduced. Links may be used to link back to the article.

Positive. It may be a pink plus sign or the word “pregnant” materializing on a digital stick. A positive pregnancy test is both exhilarating and frightening at the same time. For pregnant women who do not have health insurance, the emotion brought on by said plus sign (or digital wording) tends to lean much further toward the frightening end of the spectrum. The average vaginal hospital birth ranges between $5000-$10000, according to the March of Dimes. A C-Section adds about $2000 to the cost. Complications, including prematurity, can cause costs to soar to levels which would bankrupt most out-of-pocket payers.

Of course, the most logical step for a newly pregnant, uninsured woman to take would be to get health insurance. Maybe she thought she was healthy enough to go without it before, but now that her situation has changed she better call up her insurance agent and start shopping. As simple as this solution seems, it is actually much more complicated—to the point where it could pretty much be considered impossible. Private insurance policies are not required to cover pre-existing conditions. Pregnancy is a “condition”, based on their definitions, so new plans will not accept pregnant women, since the insurers know the potential risks and costs involved with pregnancy. In many states, individual insurance programs are not required to offer maternity services for members who get pregnant after they’ve already been accepted into the plan. If the requirement isn’t imposed on them by the state, insurers will keep their distance from pregnancy, making it impossible for women to obtain coverage even before a pregnancy occurs.

As grim as this information can sound to a newly pregnant, uninsured woman, there are some options worth looking into:

Employer Coverage: Health insurance plans offered through employers are subject to much heavier regulation than plans sold on the individual market. A pregnant woman can get accepted into her employers plan even if she is already pregnant at the time she requests coverage or joins the company. The same rules apply under a spouse’s employer based plan.

Seeking coverage through an employer is the easiest way to secure coverage for a pregnancy, as long as the pregnant woman or her spouse has (or can obtain) a job for an employer with a health insurance plan. Unfortunately, this option excludes the unemployed, those whose employer does not offer health insurance, and the self employed.

There is a small loophole for the recently unemployed.  If a pregnant woman or her spouse had been employed by a business with a group health plan within 60 days of the need for coverage arising, she may be eligible for coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA).  COBRA premiums are very high, since the employer does not make any contributions.  However, the American Recovery and Reinvestment Act of 2009 allows workers who lost their jobs to apply for reduced COBRA premiums for up to 15 months.  Employees seeking COBRA continuation of coverage should contact their former employer’s human resources department for more information.

Medicaid is an option for low-income or unemployed pregnant women. Usually these women are already utilizing Medicaid for all their care needs. Things get more complicated for women who are self employed or have a pre-existing condition. Women who own small businesses can only obtain insurance on the individual market, which overwhelmingly limits pregnancy coverage. If these women earn more than the income cap for their state Medicaid program, they lose that option as well. Women who shop for insurance once they are already pregnant (and therefore have a pre-existing condition) face a similar conundrum. They cannot purchase individual coverage for their pregnancy, and if their income is too high Medicaid will not cover them.

Some states have addressed this issue, and will override income requirements in order to provide maternity coverage for pregnant women who have no other options.  Women with incomes above the federal poverty level do pay premiums.  The cost is calculated based on income and family size.  If a woman fears she has no coverage options for her pregnancy, the best thing she can do is call her county health department and explain her situation.  Usually some type of assistance can be obtained, even if it only covers catastrophic complications.  Women who earn a comfortable income often feel guilty about taking public assistance, but pregnancy complications can wipe out even a healthy savings fund.  Sometimes Medicaid is the only option pregnant women have to protect themselves and their families.

The joy of a new pregnancy can be stifled by the fear of not being able to afford a birth.  Lawmakers seem to agree that this basic healthcare need is not accessible to all Americans the way it should be. However, they are having a hard time coming up with a solution to this very complicated problem.  Until more progress is made, many women don’t have an easy way to get their pregnancies covered.  When the stress of being uninsured is stacked with other financial and emotional tolls of pregnancy, women can become overwhelmed, even to the point of putting their babies at risk due to stress.  Uninsured pregnant women should know that there are options available for every situation.  For some, obtaining coverage is a complex process filled with paperwork, exams, and long phone calls.  In the end, most women still think it is worth the effort to insist on a covered pregnancy and birth, no matter how difficult coverage may be to obtain.

Home Birth: There are many reasons women chose to have a Home Birth. Some want to avoid medical interventions and C-Sections. Some are just more comfortable at home. Others prefer working with a midwife to working with an OBGYN. Another benefit of Home Birth is cost. According to The Big Push for Midwives Campaign, the average uncomplicated, midwife-attended Home Birth totals $2,391 for delivery and all prenatal care. This is a figure similar to average out-of-pocket costs for women who have a hospital birth with maternity coverage, based on statistics from the March of Dimes.

A Home Birth isn’t for everyone. Women who birth at home cannot receive any pain treatment. Ultrasounds usually are not provided for Home Birth patients unless they chose to obtain them independently and cover the cost on their own. Women who have pregnancy complications or past C-Sections generally are not candidates for Home Birth. If a woman chooses Home Birth, it does not mean she can confidently forgo any health insurance coverage. If a complication arises during the pregnancy or birth, she will be sent to the hospital and subject to the same costs as all other hospital patients. Home Birth is an alternative for women are able to at least obtain a catastrophic insurance policy which covers complications related to pregnancy. Woman considering Home Birth should also make sure it is a good fit for their lifestyle, and be ready for the challenges that come along with having an intervention-free birth.