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Pregnant? Uninsured? Health reform offers new insurance options Posted: June 23rd, 2011

By Maryalene LaPonsie

Having a baby is an expensive undertaking. Prenatal care, as well as labor and delivery in a hospital, can cost thousands of dollars. An emergency cesarean section or other complications can easily cause medical expenses to soar.

Fortunately, health reform legislation provides pregnant women with more health insurance options - both now and in the years ahead.

Why pregnant women face challenges getting health insurance

Uninsured women who are pregnant have long found it difficult or impossible to find individual health insurance coverage because pregnancy is considered to be a pre-existing condition.

Some women may be able to find maternity coverage through an employer. The Health Insurance Portability and Accountability Act (HIPAA), a federal law, states that group health plans cannot consider pregnancy a pre-existing condition if maternity benefits are provided in an employer-sponsored plan.

Although women may be able to access maternity coverage through a group plan, individual health insurance with maternity coverage will be nearly impossible for pregnant women to find. The same protections pregnant women receive under HIPAA do not extend to individual health insurance policies. Currently, insurers can legally deny coverage to pregnant women.

Changes benefiting pregnant women

Recent changes improve a pregnant woman's chance of obtaining individual health insurance. In March 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law, and provisions of the legislation are being phased in through 2014.

Several changes went into effect in 2010, including four that potentially benefit pregnant women and new mothers:

  1. Individuals younger than age 26 can remain on their parent's group health insurance plan as a dependent. This is true regardless of whether a woman is married or pregnant. In most states, you'll need to acquire a separate health insurance policy for your newborn.
  2. Newborns cannot be denied individual health insurance coverage even if medical problems exist.
  3. Health insurance must cover certain preventive services without charging co-payments or deductibles.
  4. Insurance companies can no longer drop health insurance coverage just because a woman becomes pregnant.

A pregnant woman's options today

For pregnant women without access to group coverage, finding individual health insurance will be difficult. In 2014, insurance companies will be prohibited from denying coverage to individuals with preexisting conditions. At that time, expectant mothers will be able to more readily obtain health insurance on the individual market.

Until then, it makes sense to explore all options. For example, Medicaid and Children's Health Insurance Programs (CHIP) have been expanded to increase eligibility for pregnant women. Additionally, federal law requires Medicaid to provide coverage to pregnant women with incomes up to $20,000. In fact, many states cover women with higher incomes.

You can also try to sign up for medical coverage through a Pre-Existing Condition Insurance Plan (PCIP). Each state is required to maintain a PCIP, which makes insurance available to those who have been denied individual coverage by insurance companies because of a preexisting condition, according to the U.S. Department of Health & Human Services. However, to qualify for coverage under PCIP, you must have been denied health insurance because of a pre-existing condition.