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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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If you are an entrepreneur, your insurance situation may start out precarious, and then you get pregnant.  The best situation is to have a working spouse with good company provided health care, but we aren’t all so lucky.  What about women who are really out there in entrepreneur-land without a net?

Well, you’re a smart woman, so you picked up health insurance.  Great.  But, what if you were one of the unlucky ones who bought a health insurance policy that didn’t cover maternity and pregnancy care?????  Uh, oh. Yes, it can happen.  Similarly, your policy may consider a pregnancy put into place within the first (X) number of months to be a pre-existing condition.  Bizarre. 

In Pennsylvania, there is a state-run program called (Health Beginnings/Healthy Beginnings Plus) If you are pregnant, you may be eligible for Healthy Beginnings – a Medical Assistance program that provides comprehensive health care coverage to pregnant women during pregnancy and for their babies for a full year. The program is completely free. Call 1-800-842-2020 for more information on how to apply and where you may receive care at a location near you. You can also access Web information at www.dpw.state.pa.us, “Services for Low-Income Pennsylvanians.” If you meet the income requirements to be eligible for medical assistance, you may be eligible for this program.

You may also negotiate with a private provider for reduced rates in exchange for cash or advanced payments.  You may also check into alternate care providers.  The Bryn Mawr Birth Center is a women’s health facility located across the street from Bryn Mawr Hospital (their backup facility), and they offer “scholarship” type plans on a limited basis.  It is worth making some phone calls to your preferred provider to find out what arrangements can be made to handle your care.

We can only hope that the health care changes passed in recent years address these problems so that all new moms have access to adequate care.  Especially if they are working their butts off as risk-taking entrepreneurs.

If you are not yet pregnant, take the time to read your health insurance policy and sit down with your insurance provider.  There may be time to correct your insurance situation and ensure those premiums you’ve been paying will actually cover a pregnancy in the future, either by adding coverage, waiting out a specified time period, or switching providers. 

 

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When you are a pregnant entrepreneur, you don’t have time to be sick.  You’re on a schedule, and if youskip a beat, how will you ever be ready for your baby?  That’s one deadline that you can’t possbily miss, and you might even need to put the breaks on ahead of schedule!

Before kids, I never thought about things like getting a flu shot.  But during pregnancy, my docs highly recommended I get the flu shot, especially since we were dealing with the dreaded Swine Flu (or H1N1) the year I was pregnant with my firstborn.  

“Flu is a terribly uncomfortable illness at best, and for many it can be life-threatening,” says Andrea Hanaway, M.D., board-certified Emergency Medicine physician and PriorityCare’s medical director. “Getting a flu shot truly is one of the easiest things people can do to stay healthy this winter.”

The flu is caused by various influenza viruses. Symptoms include fever, coughing, sore throat, aches, chills and fatigue. Most healthy people recover without problems, but people 65 and over, pregnant women, young children and people with chronic health conditions are at higher risk for serious complications and even death.

If you are already a mom, you probably know that your kids are the shortest distance between you and an illness.  The Centers for Disease Control and Prevention recommends everyone at least 6 months old be vaccinated against seasonal flu. The CDC also says that children ages 6 months to 8 years who did not get at least one dose of the 2010-2011 flu vaccine should get two doses of the vaccine this season. According to the CDC, October is the best month to receive a flu vaccination.  

Healthy Pregnancy with a Flu Shot

For those who don’t have timely access to a physician’s office, PriorityCare is the perfect location for high-quality, expedient and cost-effective flu vaccination. Flu vaccinations
are available daily, without an appointment at PriorityCare locations at Wind Gap and Bethlehem from 8 a.m. to 8 p.m. weekdays, 9 a.m. to 5 p.m. Saturdays, and 10 a.m. to 4 p.m. Sundays. Both offices are staffed by a physician, nurses and an X-ray technician.

                                      

ABOUT PRIORITYCARE

PriorityCare is a network of urgent care
centers providing quality, convenient, cost-effective medical care for
non-emergency illnesses and injuries, as well as occupational health,
preventive and wellness services including physicals, drug testing, and
vaccinations. For more information about PriorityCare, please visit www.prioritycare.net

 

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