Switching Health Insurance While Pregnant – The Facts

Switching health insurance while pregnant

Switching health insurance while pregnantIf you’re thinking of switching health insurance while pregnant, make sure you get all the facts first. The implementation of the Affordable Care Act (ACA) stipulates that health insurance policies cover costs incurred during pregnancy. Maternity coverage is essential if you want to avoid paying for costly medical bills out of your own pocket.

Costs such as prenatal testing, ultrasounds, regular visits to the doctor, and blood work plus labor and delivery at the end of pregnancy all add up. This is why getting maternity coverage from some of the best health insurance companies makes sense. There are also more affordable health plans, which offer certain benefits but not all medical expenses will be covered.

Having maternity coverage gives you peace of mind that your pregnancy will be taken care of when it comes to medical bills. But what if your circumstances change and you need to look for another health insurance plan? Can you switch health insurance when pregnant? 

The good news is you can switch as long as you do it during the open enrollment period. There are also some allowances for changing health insurance plans during the special enrollment period. 

Switching Health Insurance When Pregnant

If you’re planning to switch your health insurance plan during your pregnancy, talking to your health insurance advisor is recommended. Your advisor will always recommend you review your health insurance plan when planning to have a baby. They can also assist you if you’re wanting to switch to one of the best health insurance companies while pregnant.

While the ACA does classify maternity care and delivery of the baby as essential health benefits, coverage may vary depending on the plan.

Planning ahead for all expected pregnancy costs will allow you to determine if your health insurance plan is sufficient when it comes to covering these costs. A burning question could be “What out-of-pocket expenses can I expect to pay during my pregnancy?”

Find out if all pregnancy and prenatal costs are covered, including labor and childbirth expenses. Will you need to cover certain costs for your hospital stay during childbirth? Find out about lower co-payments when using a doctor and hospital that’s part of your health insurance network.

The answers to these questions will determine whether you need to switch to a different health insurance plan while pregnant during the next open enrollment period.

Other circumstances such as losing your income, changing jobs, or moving residence during your pregnancy may also be the reason you want to switch your health plan.

Switching Marketplace Plans During Pregnancy

A marketplace plan can’t deny you maternity coverage or charge you to higher premiums when applying for health insurance. All pregnancy and prenatal costs must also be covered from the day your plan is activated.

However, when switching to another health insurance plan during pregnancy, you’ll need to do it during the open enrollment period, which normally starts on the 1st of November of every year.  Pregnancy is not considered a qualifying event, although this does vary from state to state.

You can contact your state health department to find out if you’re eligible for the special enrollment period because of where you are living.

Changing Plans During The Special Enrollment Period

A qualifying event does allow you to switch plans during pregnancy. Besides finding out what your state considers to be a qualifying event, the following also applies according to  HealthCare.gov and the changes made recently.

COVID-19 Pandemic

If you lost qualifying health coverage more than 60 days ago, but since 1 January 2020, because of the pandemic, you may apply for health insurance in the special enrollment period.

Change Of Residence

Moving to a new home, moving from another country into the U.S, changing schools as a student, and moving from the place you live or work as a seasonal worker all qualify you for this period.

Losing Job Coverage

You may be eligible for switching to another plan if you lose coverage from your employer’s health insurance plan during special enrollment.

Loss Of Individual Health Insurance Plan

If your marketplace plan no longer exists, you may be able to switch to another plan during this period.

Loss Of Medicaid Eligibility

Should your household income status change during your pregnancy and you’ve been on Medicaid, you could lose your eligibility as a member. You may apply to switch to a marketplace plan during special enrollment if this is the case.

To qualify for any of these events and others, you can contact your local health department for more information or speak to your health insurance advisor.

Switching Health Plans When Changing Jobs During Pregnancy

A question many expectant working mothers ask is: Can you switch health insurance while pregnant and changing jobs? The answer? You may have to wait when enrolling in a new employer’s health insurance policy. 

This may not be such a problem if you’re in the early stages of your pregnancy and close to the next open enrollment period. But if your pregnancy is in advanced stages, you may need to put other measures in place until maternity coverage becomes available again. You could consider joining your former employer’s COBRA plan for maternity coverage until open enrollment.

Frequently Asked Questions

Can I Switch To Medicaid Or CHIP During My Pregnancy?

If you’re pregnant and can’t afford a marketplace plan, you can apply for maternity coverage from Medicaid or CHIP. Other circumstances such as a drop in your household income or loss of insurance through your employer also allow you to be insured through these two plans.

Medicaid is regulated by the federal government and ACA and must offer maternity coverage similar to marketplace plans and employer plans. There is no waiting period to join Medicaid, and you can apply at any time. Eligibility is based on income and household size, with a household income being less than 138% of the federal poverty level.

Pregnant women may apply for maternity coverage at the Child Health Insurance Program (CHIP). Eligibility is also dependent on the household income being less than 185% of the federal poverty level. Certain states allow for full maternity coverage, while other states ask the pregnant woman to contribute to premiums and coinsurance.

Are There Other Options I Can Use If I Change My Job During Pregnancy?

A solution would be to enroll in your previous employer’s COBRA plan. This will give you all the same benefits as your previous health insurance plan, but it will be more costly. However, you’ll need to weigh this against any potentially expensive medical bills due to unexpected situations that could arise during your pregnancy.

Final Thoughts

While it’s recommended that you not switch your health insurance plan during pregnancy, circumstances can change at any time. ACA regulations stipulate that every pregnant woman is entitled to some form of maternity coverage. If she needs to switch plans during pregnancy, there are solutions.

The essential factor is to be aware of the open enrollment requirements. Switching health insurance plans is only allowed during this period. However, if your situation becomes a qualifying event, you have the option of making a special enrollment application.

By ensuring you’re fully informed of all the options available to you, switching health insurance while pregnant is possible. Contacting either your health insurance advisor or your local health department will give you all the information you need. The solutions we’ve presented should help you make the right decisions.

We would love to hear from you if you’ve recently switched your plan during your pregnancy. What steps did you take? Let us know in the comments section below.