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Health Reform 101

with Lisa Zamosky

WebMD helps readers understand their health insurance and the new health care reform law. The Affordable Care Act is bringing sweeping changes to American health care. Lisa Zamosky is here to help you navigate the health care maze and understand how these changes affect you.

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Thursday, February 16, 2012

Before You Get Pregnant: Three Health Insurance Mistakes Women Should Avoid

By Lisa Zamosky

Insurance Mistakes

When you decide you’re ready to have a baby, it’s a good bet that health insurance coverage isn’t at the top of your mind. Yet, giving careful consideration to all of the health care costs you’ll incur from the start of your pregnancy to the birth of your baby is an important part of family planning. In fact, the best time to think about how you’ll pay for your pregnancy is well in advance of becoming pregnant.

Unfortunately, many women are caught off guard by what their plans cover, or, more often, what they won’t.

If you or someone you know is of child-bearing age and is thinking of starting or expanding a family, here are three health insurance mistakes you don’t want to make:

1.      Assume pregnancy is covered: By law, most group health plans must cover maternity care. But if you work for a company with 15 or fewer employees or you buy insurance on your own, it’s unlikely that your plan includes maternity benefits. In fact, a 2009 report conducted by the National Women’s Law Center found that 87% of individual health plans sold did not include maternity care.

If you buy your own health insurance, you’ll need to purchase a maternity rider. That can be pricey: Health plans with maternity riders cost about 61% more than those without, according to data culled from nearly 390,000 individual health plans sold in 2011 by online insurance broker, eHealthinsurance.com.

2.      Wait to buy coverage until you’re pregnant: According to a study released last year by the nonprofit Guttmacher Institute, roughly 50% of pregnancies in the United States are unintended. That leads to a lot of women being left out in the cold when it comes to having the appropriate type of insurance coverage.

Unfortunately, if you just learned that you’re pregnant and don’t have insurance, you can’t bet on being able to buy coverage now. Pregnancy is considered a pre-existing medical condition and typically leads to denial of coverage for a woman who applies for insurance on the private market.

There are a few bright spots, though: A handful of states require insurance plans to include maternity benefits in the individual and small group market. You can check Kaiser Family Foundation’s statehealthfacts.org website to see what the situation is in your state. And as a result of the health reform law, beginning in 2014, maternity and newborn services must be covered by all new plans sold to individuals and small businesses, as well as by all plans sold on state-based insurance exchanges (online insurance marketplaces required by the Affordable Care Act).

3.      Overlook coverage options: If you’re pregnant with no health insurance, don’t lose hope. It’s possible that your pregnancy will qualify you for Medicaid coverage (check Medicaid.gov to find out how to apply in your state). And Pre-Existing Condition Insurance Plans (PCIP), which are federally funded high-risk insurance pools created under the health reform law, may be a reasonable option for some women as well. The plans are intended to function as a bridge until 2014 when insurers can no longer deny anyone coverage. To qualify for a PCIP plan, you must be without health insurance coverage for at least six months. To learn about the program’s details, check the government’s web site and click on your state in the map of the country.

Share your experience: Was your pregnancy covered by insurance? Did you encounter any coverage surprises during your pregnancy? Share your experience in the comments section below.

Photo: iStockphoto

Posted by: Lisa Zamosky at 12:10 pm

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