California Maternity Health Insurance for the Pregnant: Is It Even Possible?
The short answer is perhaps, because there are three insurance options you might qualify for, and two state assistance programs. It's hard to get health insurance when you are already pregnant because insurance companies view being pregnant as a "Preexisting Condition," and the costs for a normal prenatal and delivery are much greater than the total monthly premiums you would pay for a California maternity health insurance plan. Additionally, if there are complications then the costs climb at an exponential rate (premature babies can use over $30,000 - $85,000 in medical costs in the first weeks of life, and more than 1 in 10 California babies are premature or underweight). Because of these costs and risks, Health insurance companies will decline applications from women that are pregnant when they apply, so other strategies will have to be explored by the mother to be, in order to get maternity coverage.
Insurance option number one is to join your company's health insurance plan, or the group health insurance plan at your spouse's company. Most group health plans offer maternity coverage, and are guaranteed issue - meaning that you can't be declined when you apply to join the group plan, even if you are already pregnant. The difficulty with this option is that company plans have open enrollment windows during which you can add the plan. If your pregnancy is outside the window, you may have to wait for the next annual window before you can join the plan. Ask your company if a special enrollment period can be set up. If not, and the normal open enrollment happens within 6 months of the time you become pregnant, this options can work.
Insurance option number two applies to women that have their own medical without maternity care. In this case, you should ask the insurance company if you can transfer to a plan that offers maternity care. Blue Shield of California will allow this kind of transition, but other health insurance companies in California will not.
The third insurance option is to apply for the Pre-Existing Condition Insurance Plan (PCIP) that was created by the Affordable Care Act and took effect on 1/1/11. This plan requires that you have been uninsured for a least 6 months, and been declined by a medical insurance company. This plan offers rich PPO benefits that will provide coverage for the prenatal care and delivery costs. The premiums for the plan will be less than what you would pay to get an equivalent medical insurance plan, and in many cases, this plan is one of the top 3 maternity insurance plans, in terms of minimizing your overall out of pocket expenses throughout the pregnancy.
If these options don't solve the problem, then look to see if there are programs offered by your State's Department of Insurance. Every state offers a version of the Medicaid program and many states offer other programs for women that do not qualify for Medicaid. The state of California offers the Medi-cal program (California's 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 http://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, 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 is an independent insurance broker that works will all the major insurance companies. Learn more about California Maternity Health Insurance. Get all the information and and instant quotes at SPF Insurance, and learn how to easily get the plan you need at affordable prices.
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