Insurance can seem more daunting when faced with the added overwhelm of an unexpected pregnancy, but it doesn’t have to be.
Pregnant & Uninsured
At 20 years old, I experienced an unexpected pregnancy, and my battles with healthcare coverage began. At the time, I was on my parent's healthcare plan, but was denied coverage by their private health share group because I was an “unwed mother.” I knew I needed prenatal care, but because I was a part-time employee and a part-time morning sickness survivor—now without coverage for healthcare costs—I started negotiating with the doctor’s office about paying in cash.
On top of that, I had no idea how my baby would be insured after she was born.
In the end, it was a journey. A journey that encompassed yelling at the computer, waiting on hold for more hours than I care to count, tears, and lots of comfort eating. Years later, I am a mom of two—and definitely not a healthcare expert. But since my abrupt plunge into navigating health insurance as a young twenty-something, I have learned a lot.
These are just some of the things I wish I had known about insurance coverage for prenatal care and my newborn, so you don’t have to battle the confusing healthcare industry like I did.
Let’s Talk About Your Coverage
Do you have healthcare coverage? As a pregnant woman, you should have coverage for your prenatal appointments as well as labor and delivery. There are three ways of acquiring coverage:
- You have a health insurance plan through your employer.
- If you are self-employed or do not have insurance through an employer, you can buy a plan off your state’s “insurance marketplace.”
- Qualify for government assistance on Medicaid. Medicaid is run by the state, so requirements to qualify will vary by state.
Each state has a qualification assessment that takes less than fifteen minutes. If you are in need of coverage, take the assessment as soon as possible.
Search “[your state] Medicaid qualification.” Look for a state government website with links to qualification requirements and the Medicaid application. Make sure you click on a “.gov” website--any website other than a “.gov” is probably not an official source.
Tip: If you need low-cost health insurance coverage for your newborn, but make too much money to qualify for Medicaid in your state, look into the Children’s Health Insurance Program (CHIP). In certain states, it covers pregnant women as well. Here is what you can expect no matter what type of coverage you have: Insurance plans generally cover a 48-hour hospital stay after giving birth (or, depending on your plan, 96 hours after a C-section).1 As the mother, your plan is what your newborn’s coverage hinges on. Newborns are usually covered for their first 30 days on their mother’s plan.
Thirty-Day Deadline
Insurance for labor, delivery, and newborns is different from insurance for any other type of healthcare. Essentially, you go into the hospital as “one person” and come out as two. Are newborns covered under mother's insurance for 30 days? The answer is yes!
For the first 30 days of life after birth, insurance attributes all newborn healthcare costs to the mother’s plan. Most insurance companies, but not all, give you a 30-day period, starting the day your child is born, to register your infant for their own health insurance.2
Health care registration can be difficult to navigate if you don’t know how it works. I’m no expert, but a friend who specializes in healthcare explained it like this:
1. Open Enrollment
In general, if you want health insurance, you have to wait for a special enrollment period called “open enrollment” to register through the health insurance marketplace. Open enrollment occurs a few months out of the year, generally in the fall, when you can register or change your healthcare plan.
Think of it like apple picking. Apple picking only happens a few months out of the year, and you need to go find the best fruit for you. If you don’t select a plan during open enrollment, unless you have a “qualifying life event,” you will have to wait until the next open enrollment period.
2. Qualifying Life Events
Big changes can happen in your life before or after open enrollment. For example, aging out of your parent’s plan, getting a job, getting married, etc. These situations are called “qualifying life events” and entitle you to edit your health coverage.
Having a baby is considered a “qualifying life event,” which allows you to do one of two things: add your baby to your current plan or find a new plan.3 So within the first 30 days of your child’s life, you’ll need to decide between those two options.
Before your baby is born, research what this process looks like for you. For example, if you are on Medicaid, you can call to report the birth and have them add the child to your plan. If you are covered by a plan as a single individual, either by your employer or on the marketplace, you can add a person or change to a family or group health plan. You can also look for totally different health insurance coverage.
This is the most important thing to remember: if you miss the 30-day deadline, you’ll have to wait until the next open-enrollment period, and your baby may go without health insurance for a few months. That can get costly after their first several well-child visits.
In-Network vs. Out of Network
Write these terms down now: in-network and out of network. In-network means your insurance company has a contract to work with a specific healthcare provider.4 You need to check with the insurance provider, your healthcare providers, and the hospital to figure out what they consider “in-network.”
If you see a doctor or midwife that is “out of network,” your insurance may deny your labor and delivery claims. If you do not have a doctor yet, ask your insurance provider to send you a list of midwives or OBGYNs that are considered “in-network.”
Or you can reverse engineer the process. Maybe you don’t have coverage yet, but there is a doctor you know you’ll want to see for prenatal care. Figure out what insurance they take, and then get on that plan. If you really like planning ahead, ask for their list of in-network pediatricians as well.
In-network options may seem limiting. Mothers on a Medicaid plan may worry they won’t have access to the same quality care that private insurance offers. For pregnant women, quality care is important. So be picky, but have hope. I was on Medicaid and found an incredible midwife group and delivered at a wonderful hospital.
But I also did a lot of research before I settled on what care I wanted. I asked for recommendations from friends, read online reviews, and called every place I was interested in to see if they accepted my insurance.
Go to the Source
You may feel overwhelmed with questions. What if I am 23 and still on my parents’ insurance? What if my partner’s insurance is better? The “what ifs” can go on and on, but you are capable of learning to navigate it and advocating for yourself.
My advice is to go straight to the source. Call your insurance company and do research before your due date. Buy your favorite snack as an incentive or go to your favorite coffee shop to make the research more fun. Having a baby is a big deal for you, but insurance companies add babies to their coverage every day, so most will have answers.
If you are on Medicaid, call your provider first, before the state. If you are covered by your employer, ask your provider how they recommend you let your employer know you’ll be adding a person to your coverage.
And finally, remember to read through your own plan. You probably received a short document describing your coverage when you signed up, one that you probably didn’t read through at the time--I didn’t.
If you don’t know where that summary is, ask your insurance provider to email you a PDF of your full plan. Then search keywords like “pregnancy,” “child,” “postpartum,” and “delivery.” Reading your plan will help you determine your next steps and give you good questions to ask. It will also show you how to advocate for yourself if you are told you are not covered.
You’re Already Equipped
If you’ve read to this point, you already know much more than I did when I had my first baby. As a junior in college, I navigated the healthcare system for me and my child virtually alone, so if I did it, you can too.
Being prepared is the weapon that defeats worry. Your pregnancy may have been unplanned, but your insurance journey doesn’t have to be.