The short answer is possibly, 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 “Preexisting Condition,” and the costs associated with normal prenatal and delivery care are much higher than the combined monthly premiums for a California 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 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 option applies to women that have their own health insurance plan that does not offer maternity care. In this case, you want to ask the insurance company if they will allow you to switch to a plan that offers maternity care. Blue Shield of California will allow this kind of transfer, but in California the other health insurance companies will not.
Insurance option number three is to apply for the California Pre-Existing Condition Insurance Plan (PCIP California) that was created by the Affordable Care Act. This plan became available on 7/1/10, and requires that you have been uninsured for a least 6 months, and been declined by a medical insurance company. The plan provides rich PPO benefits that will cover prenatal care and delivery services, and will keep your out of pocket costs to less than you would pay with most of the regular maternity insurance plans. This plan is one of the top 5 maternity insurance plans, in terms of minimizing your overall out of pocket expenses throughout the pregnancy.
If the above options don’t help you, you do have other choices. Depending upon what state you live in, there are government programs to provide 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.
Your state Medicaid program, or Medi-cal in California, should be your starting point. If you meet the income limits for Medi-cal you can apply for this no-cost health plan that provides benefits for pregnant women. Medi-cal is intended to provide coverage for low income families and women that are below the federal poverty level. If your income is above the Medi-cal qualification levels, then you should apply for the AIM program.
The AIM program is provided for middle-income families that don’t have maternity health insurance, or have a health plan with a deductible or co-payment greater than $500. AIM is a low-cost program that you may qualify for if your income is too high to meet the Medi-cal limits. For example, a single mother’s monthly household income can be between $2,453 to $3,679 and qualify for AIM (there is a table with income ranges for families of difference sizes at http://www.aim.ca.gov/Costs/Income_Guidelines.aspx). One caveat for the AIM program is that it’s funding is provided by the State of California, and although money is usually available, if the program fully utilizes its available funds, then no additional mothers will be enrolled.
Although maternity health insurance is not usually available after you become pregnant, the costs associated with maternity care and delivery can make having a baby a financial disaster, unless the mother has good maternity insurance. The above five options can provide either insurance coverage or non-insurance assistance by joining a group health insurance plan through your company or your spouse’s company, transferring to a plan that offers maternity coverage, applying for the PCIP plan, or exploring the Medi-cal and AIM programs (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.
Tim Thompson writes about the insurance industry. Find more about California Maternity Health Insurance, by visiting SPF Insurance to get instantCalifornia Health Insurance Quotes for your needs.