Last week, I was talking to my mom about why I wasn’t on the pill—a subject she she feels periodically entitled to bring up—when she said: ‘Well, just don’t get pregnant right now. You don’t have health insurance, and pregnancy is a preexisting condition, you know?‘ I did not know. But it turns out, in only 17 states can a mother-to-be to buy health insurance with pregnancy and childbirth coverage included, according to the Philadelphia Inquirer. In many states, it’s difficult for an uninsured pregnant woman to find individual health insurance coverage at all.
This is because pregnancy is considered a “preexisting condition.” That means a woman can be denied health insurance coverage, or at least coverage that includes maternity costs, because she is pregnant. In some ways, this makes sense — if you are already pregnant and searching for health insurance, that pregnancy is, indeed, preexisting. But facing a pregnancy and childbirth without health insurance is a daunting financial proposition:
The latest available government data show the average cost of care for a vaginal birth is $6,200, while a cesarean section with complications costs an average of $15,500. These figures exclude the costs of doctors’ fees, anesthesia, and newborn care. Taking into account the cost of doctors’ fees (but not of anesthesia and newborn care), the organization Childbirth Connection puts those figures at $9,617 for a vaginal delivery and $21,495 for a cesarean with complications.
Complications can be reduced with good prenatal care. But that costs additional money.
If the federal health care law of 2010 survives court challenges, insurers will be barred from denying coverage to adults with preexisting conditions—including pregnancy—beginning in 2014. Until (and if) then, here are a few important things to keep in mind about finding or switching health insurance plans if you’re pregnant. • When you are changing jobs, you can’t be denied employer-sponsored health insurance at your new job just because you are pregnant. And your new plan can’t deny claims related to your pregnancy, as long as the new plan already includes maternity coverage. Likewise, if you had prior health insurance coverage while pregnant and are simply switching plans, any new group health insurance policy you obtain must cover prenatal and childbirth costs‚ as long as it generally includes maternity coverage. These rules only apply to group, not individual, health insurance plans. • Even when switching between group insurance plans, you may have to sit out a 1-month waiting period before pregnancy costs will be covered. • When pregnant and leaving a job with health insurance benefits, you could be eligible for maternity health insurance under COBRA through that employer. This will cover you for 18 months, as long as you apply within 60 days. COBRA coverage isn’t cheap, but ultimately less expensive than paying pregnancy and childbirth costs out of pocket. • If your income falls under a certain range (generally up to 200% of the federal poverty level, but it varies by state), you could qualify for Medicaid, which offers health insurance to low-income pregnant women. Local health departments and nonprofit organizations sometimes offer low-cost pre-natal programs for pregnant women without insurance. You can check out state-by-state pregnancy coverage rules here.