Getting health insurance after discovering that you're preganant?

[element2012]

Hello ladies,

I am 10 weeks and about to start prenatal care with my midwife.  We (DH and I) are self employed and uninsured (never been sick!) and were planning to just pay out of pocket for the midwifery care.  I realized today that it might be smart to start considering getting health insurance in case of the off chance of needing a ceasarian when the time comes.  Does anyone have any experience with this? I honestly have NO idea about how to approach this.  I am in FL if that makes a difference.

[carseatqueen]

Have you checked into Medicaid? I've heard that it's very easy to get coverage in Florida when pregnant and uninsured.

I self-payed with a Midwife for my last two and current pregnancies. We do have insurace, but it doesn't cover prenatal care or birth. However, if I needed a medical necessary c-section it would cover the surgery and also any possible nicu time or issues with the baby. I believe there is a legal reason it has to cover a medically necessary c-sec in Florida.

Thankfully, we've never had to use the coverage for that. I know paying OOP for the birth is much cheaper for us that carrying maternity coverage- even if it was allowed to only carry it 9 months.

Where in Florida are you? I know a health insurance "broker" in our area that has been very helpful to us since only Dh has insurance through his work- we get out families insurance seperately.

[Peony]

Your options at this point would be something like a state run health insurance or Medicaid, all income based of course so not everyone qualifies. Private insurance with maternity riders require holding the policy for x amount of time prior to getting pg. Group insurance policies that you would get through an employee are not subject to those same rules. DH is self employed and I don't work enough hours to qualify for insurance, but our income is to high to qualify for programs.  We self pay for maternity things and hope nothing goes wrong. 

[element2012]

Hmmm... I guess I will make a few calls and hope for the best.  Thanks for your input!

[CDsMom1031]

Thanks to Obama (If you're in the US), no insurance can deny you because of a preexisting condition. My wedding was a week after I found out I was pregnant (Convenient, eh?), so I was uninsured when I found out. My insurance didn't come into effect until 30 days after our wedding, so I was almost 9 weeks pregnant before my first appointment, but insurance has paid for everything.

However, being self-employed, I don't know the rules about all of that.

Good luck!

And yes, Medicaid would be a good option. It'll also back pay any of your bills once you get approved.

[Mommel]

While this may be true, they CAN deny specific treatment as it relates to that preexisting condition... meaning that they will insure you if you have the flu, but if you have a pregnancy-related condition, they don't have to cover you for a certain period of time (in my case, it was up to six months when I checked on it in March... and that wasn't even a straight insurance company - they were worse - this was state health care coverage on a sliding scale!). 

Originally Posted by TTCChloeOrConner 

Thanks to Obama (If you're in the US), no insurance can deny you because of a preexisting condition. 

I couldn't afford health care premiums, especially ones that weren't even going to cover my pregnancy, which was the whole reason I wanted insurance in the first place, so I went back to school and took more loans for additional income, while reducing my work hours just long enough to have a history of a low enough salary to qualify for medicaid to cover my midwifery care. I was lucky enough to be in a position to be able to do that... I have yet to finish my degree, my boss was okay with me working just part-time, I was able to sell my car and move closer to public transit, etc... I have no idea how other people do it!!

[hildare]

i second looking into medicaid.  the income limits for pregnancy medicaid are actually pretty high.. and at least a few years ago in georgia, they did not count your assets (non liquid) against you.  there was a big push for everyone to qualify for prenatal care in recent years. 

[Susanneprincess]

we have a limited ins policy and when I found out I was pregnant I could not get any maternity ins. My DH is self employed and it was suggested to look into medicaids pregnancy program. It worked out really well and I got coverage. The income requirements are higher and you get credit for working in my state. Assets made no difference. I think they want everyone to be able to have some sort of maternity care and coverage. So I feel we have been blessed with this temporary coverage.

Smiles

Susanne

[redbirdlady]

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

HIPAA law states that pregnancy cannot be considered a preexisting condition under any insurance.  If an insurance company is denying procedures based on a pregnancy diagnosis, they are in violation of federal HIPAA law.

[Mommel]

I told them the same thing, but was told that state health insurance is exempt from such laws... I was applying for the Oregon Medical Insurance Pool, which is a sliding scale medicaid program. They told me that pregnancy procedures would not be covered for the first six months and that the laws about pre-existing conditions did not apply to state or government assisted health insurance programs. The plan would have been $400/mo. and my midwife only charged me $250/mo. Now I qualify for medicaid (I basically stopped working and chose to become poor so that I could get insurance just in case I have an emergency c/s - it's seriously messed up, as far as I'm concerned) thanks in part to my midwife's directions on how to circumnavigate the system. :(
 

Originally Posted by redbirdlady 

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

HIPAA law states that pregnancy cannot be considered a preexisting condition under any insurance.  If an insurance company is denying procedures based on a pregnancy diagnosis, they are in violation of federal HIPAA law.

[element2012]

Bumping an old thread because new questions have arisen...

I am now 16 weeks and have called around, I can get coverage but would have to have been paying for maternity coverage 30 days before finding out I'm pregnant to have it apply to that pregnancy.  Medicaid is not an option. No big deal, I've already started with my midwife and am happy.

So now the new questions.... I obviously still need to obtain health insurance before the LO arrives.  It seems to me that with any insurance policy, if I had an emergency c-section, they would have to pay the amount that is over the deductible right?  When would the premiums go up, after the baby is born?  How does that work?  Sorry, I really know nothing of health insurance, the last time I had it was under my parents! YEARS ago!

[camprunner]

Our premiums went up adding our newborn. I was surprised to find out that insuring a child 0-4 years is quite a bit more expensive than insuring a child over 4. 

[Mommel]

This might be the case and it might not. Depending on the policy, they can have limits to what they cover. For instance, I had a policy that had a small deductible, but it only covered a small amount for the surgery I had (laproscopy to remove my left tube when I had a tubal pregnancy last fall) and then the remainder was my responsibility. Actually, it was a limit to my entire coverage for the year... so yes, they pay for things after the deductible, but sometimes they have caps on total coverage and sometimes caps on certain procedures... so read your policy carefully and ask your agent about what's covered and what's not. Don't be afraid to go to an agent. You won't pay more for your policy that way because agents actually get paid by the company, not by extra premiums. You only have to worry about life insurance salespeople profiting from your ignorance, not health or car insurance salespeople. LOL
 

Originally Posted by element2012 
It seems to me that with any insurance policy, if I had an emergency c-section, they would have to pay the amount that is over the deductible right?  

Edit: be sure to ask a LOT of specific questions and don't be afraid to ask too many.