With the implementation of the Affordable Care Act (ACA, otherwise known as Obamacare), almost all insurance plans are now required to provide maternity coverage. Prior to 2014, most individual health insurance policies did not include pregnancy and prenatal care as a standard benefit under the terms of coverage.
You could purchase maternity coverage as an additional rider. These supplements are often very expensive because the insurance companies knew that if you were buying this additional coverage then you were likely going to use it. Therefore, it was priced very high. This practice was just one of the many that contributed to the need for the Affordable Care Act to be passed and enacted.
You may have chosen to keep an existing policy that has been grandfathered in because it was purchased or renewed prior to January 1, 2014. If this is the case, then you are not protected by the ACA requirement for maternity coverage. Unless you choose to purchase the optional coverage rider, you will continue to be without coverage for pregnancy care until that policy expires on or around September 2017, when the accommodation for grandfathered policies ends.
Some individuals may also be without maternity coverage if that person is a dependent child on a large group plan. Since children are now allowed to remain on their parents’ coverage plans up until age 26, maternity coverage for these dependents is typically not available. Although preventive care is now covered, the additional costs associated with labor and delivery are not.
There are some individuals who have purchased coverage that falls outside of the guidelines of the Affordable Care Act. Policies such as certain forms of short-term or temporary insurance, discount and supplemental plans do not need to conform to the federal mandates and most likely won’t provide maternity coverage.
You Have Options
If your health insurance doesn’t provide maternity coverage, there’s no need to panic. You have alternatives available to ensure a safe pregnancy.
The place to start should be your local Department of Health which can provide basic maternity care to individuals making low incomes. You will need to meet certain income requirements and, if you do not, the Health Department can provide you with alternative resources that are located in your community.
Among those include Community Health Centers which have been given additional funding as part of the Affordable Care Act to offer comprehensive primary and prenatal care to individuals without maternity insurance. The costs of these services are determined along a sliding scale based upon your annual income and how much you are able to pay.
You can also do some research into which hospitals and health clinics in your area participate in the Hill-Burton Act. These facilities must offer free or low-cost maternity care to individuals as a condition of receiving grants through this legislation. There are currently 180 participating medical facilities. If you find one in your area, you can visit the admissions office and apply for Hill-Burton free or low cost care.
There are eligibility rules in place to determine if you qualify based on your income and anyone seeking out this care need not be a US citizen. One thing to keep in mind however, is that each Hill-Burton facility has a limited amount of funds to spend annually under the grant. When that facility’s funding runs out they are no longer under obligation to provide services at low or no cost.
Catholic and Lutheran charities also provide programs for helping out expectant mothers and families that do not have maternity coverage. These can vary from counseling and referrals to free maternity and postpartum care, as well as parenting classes. Some of these charities even have room and board available for those who are in need of a roof over their head.
Another option is Planned Parenthood. Many locations provide prenatal services and counseling for pregnant women with fees that are also based on your income and your ability to pay. If you do not qualify for their care, they can refer you to resources that are available in the area that should be able to help you.
Incurring Out of Pocket Costs
Since you do not have maternity insurance, you are going to need to pay for services from your own resources. Many facilities are willing to work with you in negotiating discounted rates and payments plans to help ease the pressure on your wallet.
Always ask the hospital or clinic providing your coverage about a rack rate or a charity rate. The facility may be able to offer you either of these things, but only if you ask; it’s unlikely they will be forthcoming about these discounts. You may be required to meet certain income levels for eligibility. Even if you don’t meet those requirements the rate that is offered can help you negotiate a price that you can afford.
You also have the option of applying for a Discount Medical Health Plan. If you sign up with a company that provides these plans, you can get pre-negotiated discounts that come with membership. While it’s not maternity insurance, a discount health plan can help reduce the costs associated with prenatal and postpartum care.
There is often an annual fee that comes with membership in one of these plans. You should do some research into how many and which facilities in your area are enrolled in the discount plan that you are considering. Not all facilities participate in offering pre-negotiated discounts.
Getting Proper Health Coverage
All insurance plans provided through the Health Insurance Marketplace, Medicaid, and the Children’s Health Insurance Program (CHIP) are mandated to include maternity coverage under the Affordable Care Act. You can apply for coverage during any open enrollment period, but if you discover that you have become pregnant outside of open enrollment, that will trigger a “qualifying event“.
This means you have a special enrollment period in which you are eligible to apply for a new insurance plan outside of the allotted open enrollment. Any plan you choose, whether through private insurance or by way of a government program, will cover the costs of maternity care throughout the term of your pregnancy and even after your child is born.