The short answer is probably, because you might qualify for one of three California maternity health insurance options or two state government assistance programs. It’s hard to get health insurance when you are already pregnant because insurance companies view being pregnant as a “Pre-existing Condition,” and the costs for a normal pre-natal and delivery are much greater than the total monthly premiums you would pay for a maternity health insurance plan. Additionally, if there are complications then the costs climb at an exponential rate (premature babies can use over $30,000 – $85,000 in medical costs in the first weeks of life, and more than 1 in 10 California babies are premature or underweight). Because of these risks and costs, health insurance companies will decline applications from pregnant women, so other maternity coverage options have to be explored.
The first alternative is to join a group health insurance plan at the company you work for or 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. The difficulty with this option is that company plans have open enrollment windows during which you can add the plan. If your pregnancy is outside the window, you may have to wait for the next annual window before you can join the plan. If your pregnancy occurs within a few months of the open enrollment period, then you can use this option and simply pay for the cost of the early prenatal visits out of pocket, until you are on the group plan.
The second option applies to women that have their own 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 will allow this type of transfer, but the other maternity health insurance California companies will not.
Insurance option number three is to apply for the Pre-Existing Condition Insurance Plan (PCIP) that was created by the Affordable Care Act. In order to qualify for PCIP you need to have been declined for coverage by a health insurance company, and not had health insurance for at least 6 months. 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 options above don’t help you, there are two non-insurance options. Every state offers a version of the Medicaid program and many states offer other programs for women that do not qualify for Medicaid. The state of California offers the Medi-cal program (California’s version of Medicaid), and the Access for Infants and Mothers (AIM) program.
If you don’t have a California maternity health insurance plan and you are pregnant, you should check with Medi-cal first to see if you qualify for their program. The Medi-cal plan is a zero-cost health plan for women whose income falls below the federal poverty level. 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 health insurance and whose income is too high to qualify for Medi-cal. AIM provides low-cost health care coverage for pregnant women, and is also available to women with health insurance plans that have a maternity-only deductible or a co-payment of more than $500. Eligibility for AIM requires that a single mother have a household income between $2,453 and $3,679 (there is a table with income limits for families of various 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 three insurance options and two non-insurance assistance programs. 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 get maternity health insurance California residents have the five solutions outlined above.
