California Maternity Health Insurance For The Pregnant: Is It Possible?
The short answer is perhaps, because there are three California maternity health insurance options you might qualify for, and two state assistance programs. The reason it’s hard to get health insurance for pregnant women is that the insurance companies view being pregnant as a “Pre-existing Condition,” and the costs associated with normal pre-natal and delivery care are much higher than the combined monthly premiums for a maternity health insurance plan. Plus, if there are complications, the costs to the insurance company can climb exponentially (the cost of a premature baby is between $30,000 – $85,000 over the first few 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 health insurance with maternity coverage.
The first insurance option 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 you won’t be declined, even if you are already pregnant. 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. Check to see if your company can enable a special enrollment exemption for your situation. If not, then you will have to pay for the early prenatal visits, until you are able to enroll into the group plan. As long as the enrollment period happens within 6 months from the time you become pregnant, this option can work.
The second alternative is for women that have a private or individual health insurance plan that does not offer maternity care. For this situation, you should ask the insurance company if you can move to a plan that provides maternity care. Blue Shield of California allows this kind of transfer, but the other maternity health insurance California companies won’t.
Insurance option number three is to apply for the Pre-Existing Condition Insurance Plan (PCIP) that was created by the Affordable Care Act. This plan requires that you have been un-insured 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 health 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, there are a couple of non-insurance options. Depending upon what state you live in, there are government programs to provide assistance and 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.
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. 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). A word of caution about he AIM program, is that it is funded by the State of California, and if the funding is cut or the program fills up, then no additional mothers will be enrolled.
Although California 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. There are options that can provide insurance coverage and non-insurance assistance. Joining a group health insurance plan through your company or your spouse’s company, transferring to a plan that offers maternity coverage, or applying for the PCP plan are your insurance options. The non-insurance assistance options are Medi-cal and the AIM programs. To find good maternity health insurance California citizens can work through the five options above to find a good solution.