Q&A: Health Coverage for Pregnancy


A visitor to the site recently contacted us asking about how to handle being already pregnant with a basic health insurance plan that has no maternity benefits. We did our best to suggest an alternate route to paying out-of-pocket for months of continuous care and delivery. Below is her letter and our response:

Question:

Hello, and thank you for your very insightful website.  I’m not even sure if this is the right place to ask, but I’ll give it a shot anyways.

I just found out I am 7 weeks pregnant.  Pleasant surprise but still very unexpected.

My fiance owns his own company so he doesn’t have insurance through his work, and I have Blue Cross Anthem Smart Sense, which I believe has no maternity coverage.  I don’t want to call and let them know I’m pregnant quite yet in fears they will drop me, but maybe I should just to get some guidance. If I’m only 7 weeks could I still get the birth and hospital stay covered as that is 7 months away?

Anyways, I’m not working at the moment so I was reading on your website maybe Medi-Cal is another option.

Answer:

Thank you for browsing our site and contacting East Coast Health Insurance. First of all, Anthem cannot drop you for being pregnant. It is against the law, so you should not be afraid of losing your coverage. If you want to ask your insurance company any questions go right ahead, they can’t terminate your policy. You are correct, the SmartSense plan has no maternity benefits, but you can either pay out-of-pocket or enroll in Medi-Cal. Since you have no current income, I’m assuming you don’t want to pay out-of-pocket for delivery charges, prenatal exams, ultrasounds, etc., though that is an option.

The most money-saving bet might be to apply for Medi-Cal maternity coverage, since you already have an insurance plan and don’t have time to wait to apply for a different plan. It is unfortunately a bit late in the game to apply for another plan, as insurance companies tend to like if you apply before you get pregnant. Try Medi-Cal! This excerpt from a Medi-Cal brochure states they will cover your expenses:

 

D. SPECIAL PROGRAMS:

• PREGNANT WOMEN If you are pregnant and cannot afford to pay for health care and some dental care, MEDI-CAL can help pay for medical expenses for you and your unborn. Many times you can get MEDI-CAL at no cost to you, even if you have income. Once you get MEDI-CAL, increases in your family’s income will not be counted:

  • during your pregnancy, and postpartum period,
  • for your baby’s first year of life.

 

Participating perinatal providers throughout California can offer pregnant women immediate, temporary MEDI-CAL coverage pending the formal MEDI-CAL application under the Presumptive Eligibility program. If you are pregnant and interested in this service, ask if your provider participates in this program.

 

The following services are not automatically limited and do not need prior approval:

 

  • If you are pregnant, you can get prenatal care guidance to help you get the care you need to have a healthy baby, including some dental care

 

You can read the full brochure here.

 

Presumptive Eligibility (PE) does not cover delivery and labor charges, it is strictly pre-natal care. It will cover walk-in prenatal care and prescription drugs for conditions related to being pregnant. If you haven’t already, read the CA Dept. of Health Care Services’ explanation of PE. There is still an approval process, so apply as soon as you are able to. You must also be applying for regular Medi-Cal benefits in order to receive PE benefits, which could be a good idea anyway to cover your delivery and your child, given the limitations of your current plan. You can call someone from Medi-Cal about PE at 1-800-824-0088 if you have any other concerns about the program.

 

Always feel free to contact us with any questions you have about health insurance, no matter what circumstance, and we will try to accommodate you as well as possible.

Call us at 888 803 5917 or contact us through our comment form and we will be happy to help.


About B. Somers

B. Somers is a contributor to Health Insurance News, focusing on medical coverage, carriers, health reform and the conflicts surrounding insurance. Writing for the company's sites has provided a strong introduction to health insurance, and the opportunity to gain knowledge in the insurance industry.