Written by: Vanessa Jerusalimiec (*Amsive Digital) | Reviewed by: Shelley Wyant | *MHP partners with Amsive Digital on news content
Is Pregnancy a Pre-Existing Condition?
If you’re planning to start a family, you’ve probably been thinking about your health insurance. You want to ensure you and your family have the right coverage so you’ll be ready for whatever life throws your way.
You may be wondering whether pregnancy is considered a pre-existing condition and how being pregnant when signing up for a health care plan can affect your coverage.
Key Takeaways:
- Understanding Pre-Existing Conditions: A pre-existing condition is any health issue that existed before you enrolled in a new health insurance plan.
- Pregnancy and Insurance Coverage: Under the Affordable Care Act (ACA), pregnancy is not considered a pre-existing condition. This means you cannot be denied coverage or charged more for health insurance due to pregnancy.
- Financial Assistance: Many pregnant women may qualify for Medicaid or other financial assistance programs to help cover health care costs during pregnancy.
- Choosing the Right Plan: It's important to find a health insurance plan that fits your specific needs during pregnancy, and McLaren Health Plan offers options that can provide the coverage you need.
First Off, What is a Pre-Existing Condition?
A pre-existing condition is any health issue or condition that you had before your health insurance coverage began. This can include chronic illnesses like diabetes, heart disease, asthma, or even something like high blood pressure. Before the introduction of the Affordable Care Act (ACA) in 2010, health insurance companies could deny coverage or charge higher premiums to individuals with pre-existing conditions.
The concept of pre-existing conditions became a significant barrier for many people seeking health insurance, especially those needing it the most. It created a situation where individuals who were already vulnerable due to their health status were further disadvantaged by limited access to affordable care.
The Affordable Care Act
The Affordable Care Act fundamentally changed health insurance in the United States. This law made health insurance available to more people, at lower costs. The ACA also requires plans to offer coverage to people with pre-existing conditions, without charging higher premiums or denying coverage.
Health insurance companies cannot refuse or cancel coverage if you get sick. The ACA ensures more access to health care, without fear of being turned away due to health history.
Is it OK to be Pregnant When You Sign Up for a Healthcare Plan?
If you’re pregnant or planning to become pregnant, you might wonder if your pregnancy will be classified as a pre-existing condition when signing up for health insurance. Under the Affordable Care Act, pregnancy is not considered a pre-existing condition. This means you cannot be denied coverage or charged a higher premium simply because you are pregnant.
All health insurance plans sold on the Health Insurance Marketplace must cover maternity care and childbirth. These plans cannot deny coverage or increase costs based on pregnancy status. This regulation applies to both private insurance plans and employer-sponsored health plans.
Your pregnancy and childbirth will be covered from the first day your plan starts. Pregnancy-related care is classified as an essential health benefit. This means all ACA-compliant plans must cover prenatal care, labor and delivery, and postnatal care. Both you and your new baby will receive necessary medical attention during pregnancy and after birth.
What If You Need Help Paying for Health Insurance During a Pregnancy?
Many families face financial challenges during and after pregnancy. Fortunately, there are resources and programs available to help manage these costs and help you get the health care you need.
Medicaid Coverage for Pregnant Women
Medicaid is a state and federal program that provides health coverage to low-income individuals, including pregnant women. In many states, pregnant women with lower incomes may qualify for Medicaid, even if they were previously ineligible. This coverage can include prenatal care, labor and delivery, and postnatal care, providing critical support throughout pregnancy.
The eligibility criteria for Medicaid vary by state, so check with the Michigan Medicaid Program to learn more. Generally, pregnant women may qualify if their income is at or below a certain percentage of the federal poverty level (FPL). If you have a higher income, you may still qualify under programs specifically designed for pregnant women, like the Healthy Moms Healthy Babies program. This program offers 12 months of postpartum Medicaid coverage in Michigan.
Some states offer the Children’s Health Insurance Program (CHIP) in addition to Medicaid. In Michigan, you can enroll in Healthy Kids, which provides coverage for pregnant women and low-income children under age 19. CHIP can be a valuable resource for those who do not qualify for Medicaid but still need financial assistance.
Subsidies and Marketplace Plans
If you do not qualify for Medicaid but still need help with affordable health insurance, you may be eligible for subsidies through the Health Insurance Marketplace. The ACA provides premium tax credits and cost-sharing reductions to lower the cost of health insurance for individuals and families with incomes between 100% and 400% of the FPL.
These subsidies can make purchasing a health plan that covers maternity and prenatal care more affordable. You can explore your options on the Marketplace and find out if you qualify for financial assistance. The open enrollment period is the best time to sign up for a new plan or change your existing coverage. If you’re pregnant or just had a baby, you may also qualify for a special enrollment period.
Employer-Sponsored Health Insurance
If you’re employed and your employer offers health insurance, you might also consider enrolling in your workplace plan. Employer-sponsored plans often provide comprehensive coverage, including maternity care. Some employers may also offer additional benefits, such as flexible spending accounts (FSAs) or health savings accounts (HSAs), which can help you save money on health care expenses.
Short-Term Health Plans: Proceed with Caution
While short-term health plans may seem like an attractive, low-cost option, it’s important to note that they are not required to cover pre-existing conditions, including pregnancy. Short-term plans often have limited benefits and may not cover essential services like prenatal care, labor and delivery. As a result, they may not be the best choice if you’re pregnant or planning to become pregnant.
Finding the Right Plan for You
Choosing the right health insurance plan during pregnancy is a big decision that can impact your health and your finances. You’ll want to find a comprehensive coverage plan, including maternity care, prenatal services and postpartum support.
McLaren Health Plan offers a range of health insurance options designed to meet the needs of individuals and families at every stage of life, including during pregnancy. Our plans provide access to high-quality care so you and your baby receive the best possible support.
Contact Us For More Support
Navigating health insurance during pregnancy doesn’t have to be overwhelming. With the right information and resources, you can make informed decisions and get the coverage you need for yourself and your growing family. Remember, pregnancy is not a pre-existing condition, and you have options to make sure you receive the care and support you need.
Contact us today to learn more about our individual and family plans. Our team is here to help you find the plan that best fits your needs so you can focus on what matters most: a healthy and happy pregnancy.
McLaren Health Plan provides quality health insurance solutions for every stage of life, specifically tailored for Michigan residents. From individual coverage to family plans and Medicare, find out which plan is right for you.
View Our Michigan Plan Options