Pregnant Without Insurance

You may be one of the millions of Americans that are living without health insurance. You know that you should probably have health insurance, but for whatever reason you have put off getting insurance. Maybe you are low income and cannot afford insurance or perhaps you have been putting off getting insurance in hopes that you will not need it. If you have an unplanned pregnancy, you may be caught off guard and not know what to do. Before you set into panic mode, try to make some phone calls and see what options are available in your state.

Medicaid and State Assistance Programs

Approximately one third of uninsured Americans will qualify for public programs like Medicaid. Medicaid is a state funded program to provide health care for eligible individuals. If you are pregnant and low income you may qualify. Pregnant moms and children under the age of six whose family income is at or below 133% of the Federal Poverty Level automatically qualify for Medicaid. Many states have higher minimum mandatory income levels (around 185-200% of Federal Poverty levels) for pregnant woman and infants and some states even cover all prenatal care for pregnant women. Check with your state to see what options are available for you.

Federal Poverty Level *

Family Size 100% 120% 133% 135% 150% 1 9,800.00 11,760.00 13,034.00 13,230.00 14,700.00 2 13,200.00 15,840.00 17,556.00 17,820.00 19,800.00 3 16,600.00 19,920.00 22,078.00 22,410.00 24,900.00 4 20,000.00 24,000.00 26,600.00 27,000.00 30,000.00 5 23,400.00 28,080.00 31,122.00 31,590.00 35,100.00 6 26,800.00 32,160.00 35,644.00 36,180.00 40,200.00 Family Size 175% 185% 200% 250% 1 17,150.00 18,130.00 19,600.00 24,500.00 2 23,100.00 24,420.00 26,400.00 33,000.00 3 29,050.00 30,710.00 33,200.00 41,500.00 4 35,000.00 37,000.00 40,000.00 50,000.00 5 40,950.00 43,290.00 46,800.00 58,500.00 6 46,900.00 49,580.00 53,600.00 67,000.00 * 2006 Federal Poverty Level See link for families over six From Centers for Medicare & Medicaid Services Medicaid Resources by State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Other Public Programs & Resources for Pregnant Women

  • WIC - Special Supplemental Nutrition Program for Women, Infants, and Children
  • Maternal & Child Health Bureau

Group insurance through your work

If your job or your spouse’s job offers group insurance you may still be able to get insurance. Check with your employer to see what your options are. Under the new HIPAA, Health Insurance Portability and Accountability Act, women are given some protection from insurance companies. HIPAA prevents insurance companies from considering pregnancy a pre-existing condition. HIPAA keeps insurance companies from not covering your pregnancy if you switch insurance companies or switch employers. However, this does not apply to someone who was not previously insured and it is also limited to group insurance (it does not apply to individual insurance plans). Many group insurance plans will cover a pregnancy even if it is pre-existing but you may have to wait through an eligibility period with your employer if you are a new employee or wait for an open enrollment if you have been an employee for a while.

What if your partner loses his job or insurance through his work?

If you had insurance with through your partner’s work and he loses his job, you should not have to wait for open enrollment to be insured through your employer. If you have group health insurance, your plan will allow special enrollment under certain circumstances such as your spouse losing his insurance. You must notify your plan within thirty days.

Maternity Discount Plans

There are several maternity discount plans. These plans are not insurance but they may reduce the cost of your pregnancy. Maternity plans charge a monthly fee for their service. They work with a network of doctors and hospitals to provide discounted prenatal care. If you do not have insurance and do not qualify for Medicaid a maternity discount plan may save you up to 60% of your prenatal care and hospital expenses.

Financing a payment plan with your hospital or doctor.

The cost of having a baby varies depending on what part of the country you are in and what type of birth you have. If you have a regular vaginal birth with no complications, prenatal care and birth may cost anywhere from $4,000 to 8,000. If you need a cesarean or have complications your pregnancy could cost $10,000 or more. Worst case scenario, if you cannot get insurance, is that you have to pay for your care out of pocket. Most doctors and hospitals will work out a payment plan with you if you do not have insurance. Call your doctor’s office or hospital to make arrangements.