UPDATED: May 2, 2021 – If you are pregnant and without health insurance in America, you may be wondering if it is financially possible to receive regular prenatal checkups. Fortunately, there are several options available, depending on your income, the time of year you are pregnant, federal and state funding, and available resources.
If you become pregnant during the open enrollment period of the Affordable Care Act, you can purchase an individual health plan that covers pregnancy in the coming year. All new care plans are required to cover maternity health benefits under the Affordable Care Act.
However, if you missed the window of open enrollment, this will not be an option for you. You must experience a qualifying event, such as losing your current coverage, getting married, becoming a US citizen, etc. Pregnancy does not count as a qualifying event, except in the state of New York.
Below are some other possibilities for finding maternal healthcare while you are pregnant:
Department of Health
This should be the first place to look for help, as most Public Health Departments offer free maternity care. Although many are limited to low-income individuals, they still have a wealth of resources for maternal healthcare in your local area, even if you don’t fit in their income criteria.
Community Health Care Center
Like the Health Departments, Community Health Centers offer affordable care to people who might not otherwise have healthcare. They do not provide health insurance, although they usually have representatives who can help you find affordable care.
They often offer flexible payment plans based on a sliding-scale fee system, so they can work with a variety of incomes. Check to see if there is a Community Health Center near you.
Medicaid is run by both state and federal governments and provides coverage options to low-income applicants. Every state has its own way of determining who qualifies as low-income.
Eligibility caps are often much higher for pregnant women, even for states that have not increased Medicaid benefits under the ACA. Eligibility numbers range from 133% of the poverty level in states like Louisiana, Oklahoma, and Idaho to 375% of the poverty level in Iowa.
If you do qualify for Medicaid, coverage can be retroactive, meaning it will even cover the prenatal visits you had before you applied.
Another great thing is that once the baby is born, he or she will also be covered by Medicaid. The enrollment period for Medicare is open all year long, so there is no time constraint for enrollment.
Children’s Health Insurance Program (CHIP)
The CHIP was intended to provide coverage for children who were otherwise uninsured, but in a few states such as Colorado, New Jersey, Virginia, Rhode Island, and Missouri, maternity healthcare is also covered.
Even though the CHIP exists for families that cannot afford health insurance, it has a higher income allowance compared to Medicaid.
All five states that allow maternity coverage under CHIP have an income threshold of 200% of the state poverty level or above. If you don’t qualify for prenatal healthcare coverage yourself , your baby might be eligible for CHIP when they are born.
Like Medicaid, open enrollment for CHIP is year round, so you don’t have to worry about when to enroll.
Hill-Burton Care Facilities
There are over 130 hospitals and healthcare clinics in the US that are required to offer free or reduced-cost healthcare to individuals. Those who cannot afford standard care costs in exchange for receiving grants and loans under the Hill-Burton Act.
You can look here to see if there is a Hill-Burton Care facility in your area. Care is provided for people with low income, but there is no citizenship requirement.
Each facility is only required to spend a certain amount of funding on patients, so use these services early before the annual funds run out.
There are many local charities depending on where you live. Some are faith-based and others are not, but they serve everyone who walks in their door.
What they offer depends on funding, the needs of the community, and the size of their clinic or charity. Some can offer maternity homes, education, work re-entry programs, parenting classes, maternity care, postpartum care, counseling, free room and board, and even clothes and supplies for your newborn.
Many have social work and counselors on hand to help you find insurance. As well as, other resources and provide emotional support during your pregnancy.
Health Insurance Through Your Parents
If you are younger than 26 years old and do not currently have health insurance through your employer, you might be eligible for coverage under one or both of your parents’ health plans.
Even if you are independent, living on your own, or married, you can still be included in your parents’ health care plan. Each health insurance company has their own enrollment period.
Some are much wider than others, and many allow open enrollment all year. If the enrollment period is limited, you will have to wait until the open enrollment period.
Just be sure that the plan actually covers maternity care for dependents, as not all plans do. Search the plan’s benefits for preventative care that includes prenatal care, labor, and delivery for dependent children.
Negotiate Paying Out-Of-Pocket Ahead Of Time
If you have not found any other insurance option, you may have to pay out-of-pocket. This is not as scary as it seems. Especially if you can work out a plan with your doctor and the hospital ahead of time.
Most doctors have separate, lower rates for self-paying patients. Hospitals have rack rates, a discount for self-pay, and a charity rate. Most patients don’t ask what the charity rate is and how to qualify for it, so they don’t receive it.
Once you find out what your total costs will be, negotiate a payment plan and start paying in advance. This will take the shock out of receiving unexpected hospital bills while you are taking care of your newborn. Your bill will be lower and you know exactly what to expect and when it will be due each month.
Discount Medical Plan Organization
If you do not want to negotiate hospital rates, you can enlist the help of a Discount Medical Plan Organization.
With a DMPO, they already have done the work of negotiating discounts with the healthcare providers. You will be paying a monthly fee as a member, remember that a DMPO is not insurance. Since you will be paying the doctor and hospital fees yourself.
Before enrolling yourself in a DMPO, make sure that your hospital and doctor are part of the plan. Since many DMPO plans have a very small selection of participating hospitals and doctors in their network.
Remember, Do The Research
It can be scary and overwhelming to be pregnant and without health insurance. There are many options out there for you, based on your income and resources in your local area.
Any work that you do ahead of time to find out about your options will make it that much easier for you to find affordable prenatal and maternity care.