The short answer is perhaps, because there are three insurance options you could qualify for, and two state provided assistance programs. The reason it's hard to get health insurance when you are pregnant is that the insurance companies view being pregnant as a "Pre-existing Condition," and the costs associated with normal pre-natal and delivery care are much higher than the combined monthly premiums for a maternity health insurance plan. Plus, if there are any complications then the costs quickly climb at an exponential rate (a premature baby can have over $30,000 - $85,000 in medical costs in the first few weeks, and premature birth affects more than 1 in 10 California babies). Health insurance companies therefore will decline an application from a woman that is pregnant at the time of the application. So the mother to be needs to explore other alternative strategies to get maternity coverage.
The first alternative is to join a group health insurance plan at the company you work for or your spouse's company. Almost all group health insurance plans offer maternity coverage. This is not an a slam-dunk however, because group health insurance plans have open enrollment periods during which employees and dependents can be added to the company health insurance plan. If your pregnancy occurs within a few months of the open enrollment period, then you can use this option and simply pay for the cost of the early prenatal visits out of pocket, until you are on the group plan.
The second alternative is for women that have a private or individual health insurance plan that does not offer maternity care. In this situation you should ask the insurance company if they will allow you to transfer to a plan that offers maternity coverage. In California, Blue Shield will allow this type of transfer, but the other medical insurance companies will not.
The third alternative is to apply for the Pre-Existing Condition Insurance Plan (PCIP) that was created by Health Care Reform. To qualify for this plan you must have been un-insured for at least 6 months, and have been declined by a health insurance company. This plan will provide coverage for pre-natal care and delivery costs, and the overall benefits and cost of the plan make this one of the best options compared to the regular maternity insurance plans, if you can qualify for it..
If the above options don't help you, there are a couple of non-insurance options. Depending upon what state you live in, there are government programs to provide assistance and care for pregnant mothers to be, so check with your State Department of Insurance to determine what your local options are. In California, there is the state Medi-cal program (Medi-cal is the California version of Medicaid), and the Access for Infants and Mothers (AIM) program.
If you are pregnant and don't have health insurance, then you should start with Medi-cal first to see if you qualify for coverage through their program. Medi-cal provides a zero-cost health plan for pregnant women that meet specific income limits. Medi-cal is intended to cover families and women that are below the federal poverty level. If you don't qualify for Medi-cal then apply to the AIM program.
The AIM Program is low-cost health care coverage for pregnant women, and is provided for middle-income families who don't have health insurance and whose income is too high for no-cost Medi-cal. AIM is also available to women who have private health insurance plans with a maternity-only deductible or co-payment greater than $500. To be eligible for AIM a single mother's monthly household income must be between $2,453 to $3,679 (there is a table with income ranges for families with other children at ( www.aim.ca.gov/Costs/Income_Guidelines.aspx ). The AIM program is funded by the State of California, and although funding is usually available, if the program is filled up, then no additional mothers will be enrolled.
Although maternity health insurance is not usually available after you become pregnant, there are options that can provide insurance coverage and non-insurance assistance. Joining a group health insurance plan through your company or your spouse's company, transferring to a plan that offers maternity coverage, or applying for the PCIP plan are your insurance options. The Medi-cal and AIM programs are non-insurance assistance options that are designed to provide maternity care to the uninsured mother. With these five choices there should be a solution for all mothers to be.
No comments:
Post a Comment