Is Pregnancy A Pre-Existing Condition For Health Insurance?
Agnus Smith | Published: June 14, 2018
Starting a new family is both an exciting and nerve-wracking time in your life. After the initial shock and joy begin to fade, the inevitable question arises, “Can we afford a baby?” Adding a member to your family is expensive, there’s no way to sugarcoat it, but how can anyone call your new bundle of joy a liability? Let’s dive in and find out whether or not your pregnancy is really considered a pre-existing condition.
Is Pregnancy Considered A Pre-Existing Condition?
A pre-existing condition is any health issue or chronic condition that you had before applying for coverage. Essentially, anything that requires additional medical benefits and costs is considered a pre-existing condition, and since there are series of checkups and tests you need while you’re expecting, pregnancy would, therefore, be considered a pre-existing condition.
However, if you were already enrolled in a health insurance plan that comes with prenatal care (which most do) before you got pregnant, then you may not have to worry. Luckily, you don’t have to worry about your pregnancy being considered a pre-existing condition, or any chronic health issue you have for that matter, which we’ll touch on in just a bit.
What About For Short-Term Disability Insurance
Short-term disability (STD) insurance providers do consider pregnancy a pre-existing condition. If you’re looking to get covered while you’re pregnant, then your best bet is to explore other options. If you get pregnant after you are already enrolled, your provider won’t terminate your policy, but the benefits won’t cover your prenatal expenses but will help with your income when you can’t work.
What About Travel Insurance?
Travel health insurance companies consider pregnancy a pre-existing condition, and may not cover you if you’re expecting. However, you may still be able to get enroll in a travel insurance plan even if you’re pregnant, but your prenatal care may not be one of the benefits.
Can You Be Denied Coverage While Pregnant?
You cannot be denied coverage for being pregnant if you are enrolling in health insurance coverage through the Affordable Care Act’s marketplace, but if you are looking to enroll in a private plan outside the marketplace, you can still be denied coverage.
The health insurance marketplace made it significantly easier for expecting mothers, and anyone with pre-existing or chronic conditions for that matter, to find affordable and comprehensive coverage. Prior to the Affordable Care Act, most women and families had to purchase pre-existing pregnancy insurance which was often expensive. Today, if you’re expecting, then your best bet is to get covered through the health exchange, and you may even qualify for a subsidy.
Switching Health Insurance While Pregnant
Switching health insurance while your pregnant is tricky. If you have private health insurance, then switching coverage while expecting may be either incredibly expensive or not possible. Remember, private health insurance companies can deny you coverage if you are pregnant.
On the other hand, if you are enrolled in an Obamacare marketplace plan, then you may have to wait until the Open Enrollment Period to switch coverage. So, while you’re allowed to switch coverage while pregnant, you may find yourself stuck with your current plan until November.
Prenatal Care Benefits
If you have health insurance during your pregnancy, then you may not have to worry about costs associated with your doctor visits. For most plans, the following prenatal benefits are typically covered (though you may want to confirm with your insurance provider):
- Sexually transmitted disease (STD) testing and counseling
- Rh incompatibility (blood condition) testing
- Folic acid supplements
- Anemia screening
- Urinary tract infection screening
- Gestational diabetes testing
- Labor and delivery costs including C-section
- Hospital stays
- Counseling for breastfeeding
- Midwife services
- Any complications associated with your pregnancy
- Neonatal care
Enrolling In Medicaid When Expecting
Medicaid does not treat pregnancy as a pre-existing condition, meaning you if you qualify for Medicaid while expecting, you cannot be denied coverage. In fact, many pregnant women turn to Medicaid or the Children’s Health Insurance Program (CHIP) for the health insurance needs.
When you are enrolled in Medicaid, you can expect the same, if not more prenatal care benefits to be covered. Medicaid is one of the most comprehensive options available, so if you’re eligible, it’s definitely worth exploring this as your pregnancy pre-existing condition insurance.
What Happens After You Baby Is Born?
Once your baby is born you will be eligible for a Special Enrollment Period. That means you are free to switch or enroll in a plan of your choosing outside the traditional Open Enrollment Period.
What The Future Of Healthcare Holds For Expecting Mothers
The Affordable Care Act made sure pregnant women would not be treated as if they had a pre-existing condition. It not only guaranteed coverage for expecting mothers but created a market that offered more affordable health insurance options for everyone with pre-existing or chronic conditions. Unfortunately, the current administration has been pushing legislation that puts pregnant women in jeopardy.
While women still can’t be denied health insurance when pregnant, the GOP has definitely been pushing a different agenda, and are looking to repeal the Affordable Care Act altogether. That would obviously be a major loss for anyone with a pre-existing condition, but for now, there’s nothing to worry about.