Pregnancy and Insurance: ObamaCare / ACA

On October 1, 2013, major provisions of the Affordable Care Act (aka ObamaCare) kick in (again). If you are pregnant, or thinking about becoming pregnant, this could matter greatly to you.

A friend of mine recently shared that she’s suddenly and happily pregnant, but in a job situation that she is desperate to get out of. She started her own side business just this year, but there hasn’t been time to ramp it up, leave her old job, and switch over to her husband’s employer-provided healthcare plan. Her immediate options are:

1. Leave her job immediately, which she desperately wants to do, and pay COBRA to continue her existing insurance to continue her current coverage, which will cover her pregnancy and delivery.

2. Leave her job immediately, and petition her husband’s employer to allow their family to begin a family policy under his company’s insurance. It is common practice, although not a given, that most companies allow an employee to opt in to company insurance when there has been a major life event, such as a spouse’s job change, divorce, or death. It is also not a given that her husband’s employer policy would cover the pregnancy, since that was a pre-existing condition.

3. Stay in her job until after her delivery.

So what chances due to ACA after October 1, 2013? Well, for one, good luck getting straight answers from anyone. Because of the political rancor surrounding this Act, and the huge changes that are going into effect, there is a sea of information and misinformation about what may or may not be changing. Over the next few months, if you find yourself newly pregnant or in a situation like I describe above, be sure to carefully document who you talk to about changes in your healthcare, and get it in writing if you can!

The big change will be the insurance exchanges that states will offer to provide affordable healthcare to just about everyone. But because each state also has the option of opting out of providing a state healthcare exchange (in which case, the state exchange is run by the federal government), the answers to questions like these are going to be different in parts of the country.

If you are a pregnant entrepreneur with no primary health insurance or spouse-provided coverage, the ACA does not mean that you will suddenly have free insurance. In fact, although the exchanges open October 1, coverage will take affect January 1, 2014 for those enrolled by December 15, 2013.

What the ACA does do for the first time, however, is prohibit insurance companies for turning an applicant down for insurance, jacking up their rates, or excluding care due to their medical history and pre-existing conditions, according to the Huffington Post. That is good news if you have not had insurance or need to switch policies during the middle of pregnancy.

Also new, health insurance policies generally will cover important things they have not in the past. Well-visits and breast pumps are covered today, while they were not just a few years ago.

However, be aware that there are loopholes and quirks in the system. If you have questions about your coverage, it won’t be a surprise if you have to make several phone calls, wade through pages of insurance information, and ask your question several different ways to get answers to your specific questions.

Still need to know more? Of course you do. Check out this helpful insurance exchange calculator tool from the Kaiser Family Foundation to see what insurance, premiums, and subsidies might look like for your family after January 1, 2014.

*Please note that I am not an insurance rep or agent. The best advice is to meet with a qualified insurance professional who can evaluate your family’s individual needs. There are also paid guides, called Navigators, who are being trained to help people through their state’s exchange programs. Please search the internet for “(your state) health care exchange” to find these trained resources.

Are you a pregnant entrepreneur and uninsured? What’s your experience getting coverage through the new health care exchanges?

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