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Health Insurance for Pregnant Women

Children are a blessing, and any difficulties future mothers may face lose their significance in comparison with that excitement and happiness that awaits them with the delivery of a child. However, at present, when the cost of having a baby is soaring, it is vitally important to prepare for motherhood not only physically, emotionally and financially, but also in terms of health insurance, which basically also combines these three important aspects.

Besides all the extra costs pregnancy naturally involves, add up the costs of prenatal visits, which can be very expensive, and the cost of delivery, which ranges from $6,000 to $13,000, depending on whether it is a normal delivery or a cesarean. Expectant mothers will depend on their health insurance for prenatal and maternity care, pediatric visits, immunizations etc. In other words, if you are an expectant mother or a new parent, good health insurance coverage is a must and becoming more and more important in the present economic situation.

Meanwhile, a research study of the American Health Association showed that over 13% of pregnant women in the U.S. do not have any health insurance. If you want to ensure your pregnancy will be adequately covered by health insurance, you are strongly recommended to plan before you become pregnant.

Apart from being a blessing, pregnancy can often complicate health and health insurance options. Women who do not have an adequate health insurance policy before they become pregnant may find it difficult to get appropriate health insurance later on. As a result, they may receive inadequate pre-natal care, deal with enormous medical bills and have to pay all the costs for their entire pregnancy out of their own pocket.

The thing is that some insurance plans consider pregnancy a pre-existing health condition and refrain from providing an insurance policy to women after they become pregnant. They consider pregnant women high risk candidates who will require more help with their health care costs, and if the law permits, they avail of the opportunity to reject such candidates.

According to HIPAA law, pregnancy cannot be treated as a pre-existing condition, which means a pregnant woman cannot be denied health insurance coverage when she switches jobs or health plans. HIPAA, the Health Insurance Portability and Accountability Act of 1996, is practically the only protection against pregnancy being considered a pre-existing condition. However, there are many cases to which HIPAA rules do not apply.

For example, it does not apply to women who previously had no health coverage, got pregnant and then got a new job with a group health plan. They will have to sit out an eligibility waiting period. This period may be longer than their pregnancy term.

In case you have individual insurance and get pregnant, and then purchase group health insurance, you are most likely to be subject to a pre-existing condition waiting period as well. Also, you may not get any pregnancy coverage if you move from one individual health plan to another.

It is essential to find out what your health insurance will cover and what it will exclude beforehand. Contact your company's benefits department or your health insurance plan's customer service and figure out whether the plan covers prenatal and maternity care and if you need preauthorization for it. You might need a referral from your primary care doctor to see an obstetrician. Ask about coverage for prenatal tests and procedures, birth, hospitals, inpatient hospital time after delivery, and every important aspect that bothers you. Figure out if your plan will cover a certified nurse midwife or pay for a delivery in a birth center, if this is what you prefer. Ask what type of maternity, preventive and well-baby care the plan will provide.

Things will get more complicated if you lose or quit your job. It may be smarter to avoid switching jobs or make any job-related health insurance changes if you are pregnant, because if you do, it is possible that you might have to wait a few months before you are eligible for coverage. When it comes to pregnancy, a few months are all-important: your baby may be born while you are still on the waiting period for your benefits, which means that you will be the one responsible for the bills.

Also, mind that the terms of your new health insurance plan could be different from the terms of your old plan, which could involve switching physicians in the course of your pregnancy, and other inconveniences.

Therefore, it is necessary to take measures to maintain your health insurance coverage if you lose or change your jobs. The best option is to continue health insurance coverage under your old employer's plan until your baby is born. The federal law, COBRA, allows you to keep your coverage for up to 36 months after you leave your job. It provides health insurance for qualified workers, their spouses and their dependent children if they are between health insurance plans. COBRA coverage is a bit more expensive, but it is well worth it if it turns out that the new plan has more restrictions than your current one or there is a waiting period for health benefits at your new place.

If you cannot immediately sign up for health insurance coverage through your spouse's employer-sponsored plan, it is best to sign up for continuation of your current health insurance through COBRA. Otherwise, you will have to pay for your prenatal and maternity care yourself.

In case you have group health coverage and then switch jobs while you are pregnant, your new health plan is likely to have a one month eligibility period before it takes effect. It means that it won't cover your pregnancy until then. If you are in your eighth or ninth month with coverage, it can be a problem.

There are certain federally funded programs which can provide medical assistance for low income persons. Medicaid is one of them. It accepts women who qualify even if they are already pregnant and helps them pay for their pregnancy costs. 

Depending on your state, there can be other options for uninsured pregnant women. You are recommended to check with your local department of health at Health Departments by State for information on local programs.

WIC (Women, Infants, and Children) is one more government sponsored option for low-income women, infants, and children under the age of five. This is a federal agency which provides referrals to health care during pregnancy, information on healthy eating and nutritious foods to supplement pregnant women and children's diets.

There are a number of alternative programs to traditional health insurance and Medicaid. These are not insurance policies but health care discount programs, such as Maternity Advantage or AmeriPlan. They can help you save more than 50% of the pregnancy costs. Make your own research into the options such programs offer and find reviews before you decide whether it suits your situation.

The arrival of a new baby will bring not only joy and happiness, but also many medical bills from the pediatrician, the nursery, etc. Before your baby arrives, you should find out about the procedure for adding your newborn baby to your health insurance plan. Ask whether the plan will cover your baby's nursery stay, well-child care including pediatrician appointments and vaccinations, and figure out the plan's rules for in-network and out-of-network pediatricians. It is very important to try and arrange things in such a way that the problems won't take away all the significance and joy of the moment.



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