How to Cover a Pregnancy With Health Insurance in the United States

Several years ago, insurers could discriminate against people with pre-existing conditions. They might refuse to cover them or charge a higher premium. In other words, if you already needed medical care, you had to pay more to get that medical care. Pregnancy was usually considered a pre-existing condition, so it was difficult for pregnant people to get an insurance plan. However, with the implementation of the Affordable Care Act in 2009, insurers can no longer discriminate against people with pre-existing conditions. It’s no different for a pregnant person to find a plan than it is for anyone else—either they will purchase a plan on the healthcare Marketplace, gain coverage through Medicaid, or buy a plan on the open market.

Method 1
Method 1 of 2:

Getting a Plan through the Marketplace

  1. In order to apply for a plan sold in the Marketplace, you’ll have to create an account. Creating an account is easy. All you’ll need is basic information like your name, email address, and physical address. [1]
    • Go to the website and click the button that says “take the first step to apply.” You’ll enter your information and choose a username and password. Then create the answers to your security questions.
    • Next, you’ll be prompted to answer a few questions about your address history. This information is gleaned from your credit report, and the questions help to prevent identity theft.
  2. Completing the application is easy. The prompts will ask you a series of questions, and you may or may not be required to provide more information based on your answers. You’ll want to gather a few documents before you start, including: [2]
    • Last year’s tax documents and a paystub from this year. Most people who buy insurance through the Marketplace get subsidized coverage or Medicaid, and there are income requirements to qualify for either. These documents help you estimate your income. Any individual who makes less than 400% of the poverty level qualifies for a subsidy (about $47,000 for an individual), and anyone who makes less than 138% of the poverty level qualifies for Medicaid.
    • Information about income and employers from the other members of your household who need coverage.
    • The policy numbers for any health insurance plans you already have.
    • Completed Employer Coverage Tool Forms, which you can find at http://obamacarefacts.com/wp-content/uploads/2014/10/health-insurance-marketplace-application-employer-coverage-tool.pdf . Your employer should complete the form—all you do is fill out your name and identifying information.
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  3. Once you’ve completed your application, you’ll be able to browse the different types of plans available in your state. There are two basic ways in which the plans differ: the amount they cost and the variety of providers you can visit and still get coverage.
    • The cost of a plan is based on two factors—the size of the deductible and the amount of the premium. The premium is your monthly bill, and the deductible is the amount of money you must pay before your insurer starts to pay.
    • There are four levels of cost in the marketplace plans, bronze, Silver, Gold, and Platinum. In a Bronze plan, your insurer pays 60% of the cost of treatment, while you pay 40%; the Silver plan pays 70% while you pay 30%, and so on with the Gold and Platinum plans. [3]
    • The size of the coverage network is indicated by the type of plan it is—EPO, HMO, POS, and PPO. An EPO, or Exclusive Provider Organization, only allows you to go to doctors within their network. An HMO, or Health Maintenance Organization, is less restrictive, but usually won’t pay for out of network care. A POS, or Point of Service plan, charges you less for in-network care and requires referrals to see specialists. Finally, PPOs, or Preferred Provider Organizations, are the most generous. While you may have to pay a little extra for out of network care under a PPO, you can go anywhere. [4]
  4. Once you’ve chosen a plan you like, pay your first premium directly to your insurer, who should have contacted you after you enrolled in the marketplace. Once you’ve paid the premium, your coverage starts.
    • If you miss a payment, you have 90 days to make it up before the insurance company can cancel your plan. If your plan is terminated and you don’t have a special qualifying condition like pregnancy or loss of a job, you won’t be able to get another plan until the next year’s open enrollment. [5]
  5. Once you’ve enrolled and paid your first premium, find a general practitioner you feel comfortable with and designate them as your primary care provider; they can direct you to a qualified OB-GYN.
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Method 2
Method 2 of 2:

Applying for Medicaid

  1. There are two ways to sign up for Medicaid, a program providing health care to certain low-income people. You can go to healthcare.gov, where they will screen you and then refer you to your state’s Medicaid office, or you can go directly to your state’s Medicaid office and apply. Since the states set eligibility requirements for Medicaid themselves, they must make the final determination. [6]
    • In states that expanded Medicaid under the Affordable Care Act, everyone who makes 138% of the poverty level qualifies for Medicaid. States which haven’t expanded Medicaid are much more restrictive in who they cover, but low income pregnant people are covered everywhere—and don’t have to pay deductibles or copays for pregnancy related services.
  2. Your Medicaid application will ask you information about your gender, household size, income, and expenses for items like rent. While you will generally be asked to provide proof of income, you might be able to sign an affidavit affirming you lack of income; a person with no income isn’t getting a paystub, after all.
    • In some states, you’ll get a decision immediately. In other states, they may call to verify information, but pregnant people usually get quicker service. In any case, once you’re approved, you’re approved. You’ll get a card, but you’ll be covered before it arrives.
  3. Your state’s Medicaid office will have a listing of doctors who accept Medicaid, and some services, like ZocDoc.com, may have their own lists. The states’ list will be the most complete, however. Find a doctor who’s close to you and make an appointment.
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      References

      1. ↑ http://obamacarefacts.com/obamacare-sign-up/
      2. ↑ http://obamacarefacts.com/obamacare-sign-up/
      3. ↑ https://www.healthcare.gov/choose-a-plan/plans-categories/
      4. ↑ https://www.healthcare.gov/choose-a-plan/comparing-plans/
      5. ↑ https://www.healthcare.gov/apply-and-enroll/health-insurance-grace-period/
      6. ↑ https://www.medicaid.gov/apply-for-coverage/frequently-asked-questions.html

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