Options If You're Pregnant With No Maternity Insurance

If you’re pregnant and don’t have health insurance, you probably feel vulnerable and overwhelmed. This article will help you understand your health insurance options, and how your pregnancy might make you eligible to enroll in coverage that wouldn't otherwise be available.

Open Enrollment for Individual or Group Health Coverage

Individual health insurance plans that include maternity coverage are available through the Affordable Care Act's (ACA) health insurance exchanges (and directly from major medical insurance companies, outside the exchange). And employer-sponsored health plans also cover maternity care. But you can only enroll in those plans:

• During open enrollment for individual/family plans, which runs from November 1 to January 15 in most states.
• For employer-sponsored coverage, the employer sets their own open enrollment window. It's commonly in the fall, but can happen any time of the year. This is because employer-sponsored health plans do not have to follow the calendar year (i.e. their renewal date can be any time of the year; it doesn't have to be January 1). You can use this window to enroll in your own employer's plan or your spouse's employer's plan, assuming you're eligible for coverage. Or, if you're not yet 26, you may have the option to enroll in your parent's employer's health plan (we discuss this in more detail below).
• During a special enrollment period triggered by a qualifying event (note that there are different qualifying life events that apply to individual/family and employer-sponsored health insurance; in general, pregnancy itself is not a qualifying life event, but there are some states where pregnancy does create a special enrollment period for health coverage obtained through the exchange/Marketplace).

If you're pregnant during open enrollment (for an individual/family or employer-sponsored plan), you can sign up for coverage. All ACA-compliant individual major medical plans are required to include maternity benefits. Long-standing rules already required maternity coverage for large group plans, and the ACA mandated maternity coverage on small group plans with effective dates of 2014 or later.

Pre-existing conditions—including pregnancy—are no longer an obstacle, which means you can enroll even if you're already pregnant, and there's no waiting period for pregnancy coverage once the policy takes effect.

Some routine prenatal care is covered in full on all ACA-compliant plans. But there will be cost-sharing—copays, deductible, and/or coinsurance—for other pregnancy-related services, including delivery, ultrasounds, etc.

Special Enrollment Periods and Qualifying Life Events

If you find yourself uninsured and pregnant after open enrollment has ended but many months ahead of the start of the next year's enrollment period, certain circumstances could provide you with another chance to enroll.

The birth of the baby is always a qualifying event, even though pregnancy may not be. It allows both the baby and parent(s) to enroll in an individual/family or employer-sponsored health plan. However, that doesn't help with prenatal care or the cost of the delivery itself.

If you're not eligible for insurance through the ACA (Obamacare) or your job, or if you need prenatal care before the next open enrollment period, you do have some options.

Local Health Department

Your first stop should be your local Health Department. Many Public Health Departments provide maternity care.

Usually, these services are limited to lower-income individuals, but if you don’t meet the income criteria, they can still provide a wealth of information on what other resources are available in your area.

Community Health Center

Community Health Centers provide affordable care to people with limited access to health care.

While they don’t provide maternity insurance, they do provide comprehensive primary and prenatal care with fees based on your income and ability to pay.

Since not all communities have one, check to see if there is a Community Health Center near you.

Medicaid

Medicaid is a government program that provides health insurance to low-income people, and the program covers about 40% of all births in the United States. If you qualify, Medicaid’s maternity insurance coverage can be retroactive, covering prenatal care you got even before you applied for Medicaid.

When you qualify, coverage for the child begins at birth. And Medicaid enrollment is available year-round, as opposed to the annual enrollment windows that apply to private individual/family plans and employer-sponsored plans.

Medicaid eligibility levels are generally higher for pregnant people than for others, and the fetus is counted as a household member when the eligibility determination is made. (More people in a household raises the income range for Medicaid eligibility.)

Here's a chart showing the income levels that correspond to various percentages of the poverty level, depending on family size. And here's a chart showing the percentage of poverty level that will make a pregnant person eligible for Medicaid or CHIP in each state.

Even in states that haven't expanded Medicaid under the ACA, pregnant people are eligible for Medicaid with incomes above the poverty level. Eligibility ranges from 133% of the poverty level in Idaho, Louisiana, Oklahoma, and South Dakota, to 375% of the poverty level in Iowa. (Note that the states use a 5% income disregard when determining Medicaid eligibility for most populations, so those limits would effectively be 138% and 380%.)

So you may find that you're eligible for Medicaid when you're pregnant, even if you wouldn't normally be Medicaid-eligible. And most states now allow the coverage to continue for 12 months after the baby is born, even if they would no longer otherwise qualify for Medicaid.

Children’s Health Insurance Program

The Children’s Health Insurance Program provides health insurance to uninsured children, but it also provides coverage to pregnant people in several states:

• Colorado
• Missouri
• New Jersey
• Rhode Island
• Virginia
• West Virginia

Although it focuses on people who can’t afford health insurance, CHIP programs allow higher incomes than Medicaid does.

All six of those states have eligibility thresholds of 200% of the poverty level or above for pregnant people to qualify for CHIP. Even if you don’t qualify for CHIP, the child might qualify at birth. Like Medicaid, CHIP allows enrollment all year long.

Hill-Burton Facility

There are 127 hospitals and health clinics nationwide that are obligated to provide free or low-cost care because they accepted grants or loans under the Hill-Burton Act.

Go to the admissions office of one of these facilities and tell them you want to apply for Hill-Burton free or reduced-cost care. You’ll need to meet low-income requirements, but you don’t have to be a U.S. citizen.

The facility is only obligated to spend a limited amount of money each year on Hill-Burton care, so you’ll have to use their services before that year’s money is gone.

This covers the hospital’s charges, but not necessarily the healthcare provider’s charges since it isn’t truly insurance coverage; it’s a type of charity care.

Charity Care Organizations

Organizations like Catholic Charities and Lutheran Services offer programs to help people with pregnancy care. Services vary by location.

Basic services include counseling and referrals. However, some locations provide services as extensive as residential homes that provide free health care, postpartum care, parenting classes, and room and board.

At the very least, they’ll educate you on what other resources are available in your local area.

Young Adult Coverage Under Parent’s Policy

If you’re less than 26 years old, you might qualify for coverage under your parent’s insurance. Even if you’re married or living on your own, you can be included in the health insurance your parent gets from his or her job.

You'll likely have to wait until your parent's plan's open enrollment to sign up, but the plan might have an open enrollment that doesn't coincide with the calendar year. This could be helpful if it allows you to enroll sooner than you'd be able to if you had to wait until the annual open enrollment period for individual coverage.

However, you'll want to make sure the plan offers maternity insurance coverage for dependents, as health plans are not required to do so. Dependents must be offered coverage that includes preventive care benefits, including prenatal care. But health plans are not required to cover labor and delivery costs for dependents. 

Planned Parenthood

Planned Parenthood isn’t just for family planning and checkups. Some, but not all, Planned Parenthood locations provide prenatal services. And some Planned Parenthood locations base their charges on your income.

If your local Planned Parenthood doesn’t provide prenatal care or have a sliding-scale fee structure for self-pay patients, they’ll be able to refer you to other resources within your local community.

Negotiate a Self-Pay Rate

If you end up paying out of pocket, negotiate discount rates in advance and set up payment plans. Frequently, hospitals have a rack rate, a self-pay discount rate, and an even lower charity rate. If you don’t ask about the charity rate, they might not volunteer it.

Discount Medical Plan Organization

If negotiating your own self-pay discount scares you, you can work with a Discount Medical Plan Organization. These companies provide pre-negotiated discounts to their members for a monthly fee.

This isn’t true maternity insurance since you’re paying the healthcare provider and hospital yourself, but the discount has already been negotiated for you by the DMPO.

Before you enroll, make sure your practitioner and hospital participate, as many plans have a severely limited selection of participating healthcare providers. If you haven't yet selected a medical professional or hospital, however, you can limit your selections to providers who participate in the DMPO.

Summary

Pregnancy is covered by virtually all types of health coverage in the United States. But with the exception of Medicaid/CHIP, most types of coverage have limited enrollment windows. In order to sign up for an employer's plan or a self-purchased plan in the individual/family market, you'll either need to enroll during open enrollment or during a special enrollment period linked to a qualifying life event.

The birth of a baby is a qualifying life event in every state, but in most states, pregnany itself is not a qualifying event. So a pregnant person who doesn't have health coverage and who isn't eligible for Medicaid may find that they aren't able to get health coverage until after the baby is born. Fortunately, there are a variety of programs designed to ensure that prenatal care is still available during these pregnancies.

A Word From Verywell

If you're pregnant and don't have health coverage, it's important to consider all of the possible ways you could get coverage. You don't want to skip prenatal care due to cost, or to go into labor and delivery without any health coverage. Even if you've applied for Medicaid in the past and been turned down, it's in your best interest to apply again if you find yourself pregnant with no health insurance.