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Thursday, March 12, 2015

A Special Enrollment Period for Pregnant Women's Health Coverage

Cathy Kaufmann

Enrollment Program Director

Looking for information about life events that qualify a person to enroll in marketplace coverage outside of open enrollment? See our popular infographic on special enrollment periods.

More than 30 consumer groups, 37 senators, and 50 House members agree: Pregnant women should be allowed to enroll in health coverage when they find out they’re pregnant, even if it is outside the open enrollment period. Pregnant women who lack health insurance often go without necessary prenatal care, thus jeopardizing their health and that of their babies. Already, thousands of people have joined with the senators to call for the creation of a special enrollment period. Families USA has signed on as a partner in this effort, and we ask that you join us to demand access to health care for pregnant women. 

What is a special enrollment period under the Affordable Care Act?

A special enrollment period allows a person to apply for marketplace insurance outside of the normal open enrollment period. To qualify for a special enrollment period, a person must experience what is called a “qualifying life event”—a major change in life circumstances such as the loss of a job or a divorce.

Currently, giving birth is considered a qualifying event that provides women with a special enrollment period to apply for coverage. Women who are seeking coverage in the marketplaces (as well as those with employer-based or other private market coverage) can enroll themselves and their newborns in coverage once they give birth

No special enrollment period covers pregnant women before they give birth

Unfortunately, pregnancy itself does not qualify a woman for a special enrollment period in the marketplace. 

Millions of women become pregnant each year, and—all too often—they lack health insurance, or the insurance they have doesn’t cover maternity care. And because nearly half of all pregnancies are unplanned, many women don’t know that their insurance doesn’t cover prenatal care and delivery until after they find out they are pregnant. 

If a woman becomes pregnant outside of open enrollment and she is either uninsured or has insurance that doesn’t cover maternity care, her only option for getting the care she and her unborn child need is to pay for it out of pocket. But the cost of pregnancy and newborn care can be as much as $30,000. As a result, many uninsured women forego the prenatal care they need, leading to worse health outcomes for themselves and their babies.

Lack of prenatal care can lead to serious health consequences for mother and child

Not only are pregnant women without adequate health insurance at financial risk, but if they go without necessary prenatal care because they can’t afford it, their health and the health of their babies are also at risk. Babies of mothers who don’t get prenatal care are three times more likely to have low birth weight and five times more likely to die than babies born to mothers who do get adequate care. And pregnant women themselves are far more likely to die of pregnancy-related complications if they go without prenatal care.

Coalition of advocates working to create a special enrollment period for pregnant women

Young Invincibles, a group focused on elevating young peoples’ voices in the health care and other policy debates, is leading a coalition of advocates who want the Department of Health and Human Services (HHS) to create a special enrollment period for pregnant women. Their efforts seem to be paying off. As of March 10th, 37 senators and 50 House members have signed on to letters to HHS urging the agency to create a special enrollment period for pregnant women who lack maternity coverage. Allowing pregnant women to enroll in the coverage they need makes both financial and moral sense.

Families USA supports this effort, and we urge you to join us in demanding access to health care for pregnant women. Please sign Young Invincibles’ petition today!