Monthly Archives: January 2018

Affordable Maternity Health Insurance Coverage

In US, the fact is that “mother’s to be” are either under insured or they don’t have maternity health insurance coverage. Not having maternity insurance is a result of either being careless or under the impression that your individual health insurance policy includes maternity health coverage. Most likely, your health insurance policy will not include maternity care insurance. Each year in US, their are about 6 million pregnancies and among those only 13% women are covered for maternity. To start off right away, go Here. Medicaid is also a good option for pregnant women. For pregnant women, Medicaid offers special treatment if you have low family income. Although, eligibility for Medicaid under maternity insurance varies by state, by law all states must cover expecting mothers with an annual income of $20,000 as an individual. A lot of states also cover pregnant women under Children’s Health Insurance Program (CHIP). If you need more information on CHIP, you can read the article on affordable health insurance for children only. If you are a working women, then you should be having maternity coverage under your group health insurance plan. If not, then please be informed that under the federal law HIPAA (Health Insurance Portability and Accountability Act) group health plans cannot consider pregnancy as pre-existing condition and cannot deny you coverage for prenatal procedures or any other reason related to pre-condition health history. HIPAA, is only applicable to group health insurance option. The difficulty arises, when you are seeking maternity coverage in the open market through a health insurance provider.

States Where Maternity Insurance Is A Mandate To Be A Part Of Health Insurance Coverage.

As of now states where maternity coverage is a mandate for individual and family health coverage are:

Washington | New York | Vermont | Colorado | New Jersey | Montana | Massachusetts

If you reside in California, there is good news for you. Effective July 1st 2012, it is mandatory for health insurance plans to provide inbuilt maternity coverage in the state of California. Also, if you live in CA, you can also check another good program called Access For Infants and Mothers (AIM). This program is specially for uninsured women who are pregnant. One condition is, you should be within 28 or 30 months of your pregnancy for approval. This program covers everything.

Although The Affordable Care Act (Obamacare) has made purchasing health insurance much more simpler however we may not see any significant change until 2014 when the law actually comes in effect. Post 2014, maternity coverage and new born care and treatment will become a part of essential health benefits and hence will be offered by individual health plan providers and also by the health insurance exchanges which will be functional by then. Large group health insurance plans are for now excluded from this mandate.



Maternity Insurance Coverage Options Right Now

Individual Health Insurance Plan With Maternity Coverage

  • First and foremost, if you are already pregnant, then you will not be able to purchase individual health insurance plan with maternity coverage. One exception to this is, if you qualify for the guaranteed issue HIPAA sanctioned health insurance plan. Guaranteed Issue policies can only be bought if you have group coverage for 18 months at a stretch.
    As per the recent study which was conducted by National Women’s Law Center Washington D.C. on around 3,300 individual health insurance policies the results were quite shocking. Only 12% of those had maternity coverage.
  • Everything boils down to planning. If you already have an individual health insurance plan then you can add maternity insurance as a supplemental coverage. Commonly known as a rider. However, their is a waiting period attached to it. You might have to wait for 6 to 12 months before you get full maternity insurance benefits.
  • Mostly all health insurance companies offer maternity coverage on their health insurance plans as an extra add on. Before buying, compare plans through at least 3 insurance companies.
  • Just to guide you in the right direction, always purchase your health plan with maternity coverage much before planning your baby. There have been instances wherein expecting mothers have been denied coverage from their current health insurance providers for the reason which goes like this,” We cannot cover you because, you took out the policy before conceiving your baby” I know this atrocious and absolutely absurd but this practical example is mentioned so that you are well prepared in advance.


  • Even when you are covered for maternity insurance through your employer’s group plan, the stage of your pregnancy and the waiting period of your maternity coverage plays a major role. What if you are in the 8th or 9th month of your pregnancy and there is a waiting period of at least 2 months before your cover kicks in?
  • COBRA plan (specific to your state) can be used to cover this drawback of waiting period. You can enroll yourself in your former employees COBRA plan in the meantime and avail maternity insurance. As states have adapted their own COBRA laws, at times they are also referred as “Mini COBRA Laws”. Keep in mind that this can be an expensive alternative in terms of premium and deductible amount and opt for it only when it is necessary.

Planning Is The Key…. Plan Your Baby and Your Maternity To Avoid Any Waiting Period Hassle…


Pre-Existing Condition Insurance Plan (PCIP) Alternative:

  • This can be a good option for maternity insurance if you qualify for it. You need to be a US citizen and should be without any insurance coverage for at least 6 months.

Medicaid and Special Supplemental Nutrition Program for Women Infants & Children (WIC)

  • Medicaid: Medicaid is a good alternative for you if you are a low income individual for maternity insurance. If you are already enrolled into Medicaid then there is no need of filing a separate application for the new born. He or She is automatically eligible for Medicaid until the first birthday.
  • Supplemental Nutrition Program for Women Infants & Children (WIC): WIC targets low income families who are need of prenatal and post natal care. Further information on WIC can be obtained

Maternity Insurance Coverage Options If You are Already Pregnant

Maternity Card:

All health insurance plans which offer maternity insurance have a waiting period ranging from 1 months up to 2 years. This is where “Maternity Cards” come into picture. Before we discuss this option, let me tell you that it is NOT a maternity insurance coverage but an alternative if you can’t find maternity coverage. It is a mean to reduce your cost of maternity treatment pre and post delivery. Also, if you already have Medicaid then you will not qualify for a maternity card.

Maternity Card Covers the Following:

  1. It will provide cover for doctor visits.
  2. Sonograms
  3. 24/7 counseling
  4. Check Up For The New Born
  5. Hospital Stay Expenses
  6. Prenatal Treatment
  7. Fertility and Sterilization Therapy etc.


n New Mexico, the Open Enrollment deadline has not been extended. However, customers who were unable to successfully enroll in a plan by March 31 may still qualify to sign up on a case-by-case basis. Call 1-855-99-NMHIX to add your name or find out if you’re still eligible.