While pregnancy should be a joyous time, if you don’t have insurance, you may be worried about how you’re going to pay for all those doctor’s visits and tests. Health insurance is key to ensuring quality and affordable prenatal care for you and your baby. Luckily, you have several options when it comes to finding affordable care and coverage while pregnant.
Enrollment Periods and Qualifying Life Events
Individuals or families that live in Pennsylvania can enroll in a health plan during the annual PA Open Enrollment period. The next Open Enrollment Period begins November 1, 2024.
You may be able to enroll before then if you experience a qualifying life event. A qualifying life event is a change in circumstance that allows you to enroll in a health plan outside of the annual Open Enrollment Period.
The Special Enrollment Period is any time outside of the Open Enrollment Period when you may be eligible to apply for an individual or family health plan. If you experience a qualifying life event, such as getting married, having or adopting a baby, losing your coverage, turning 26, or permanently moving into a new service area, you may qualify for a Special Enrollment Period.
Is pregnancy a qualifying life event?
Although pregnancy is not a qualifying life event in most states, the birth of a baby is always a qualifying life event. This means that the birth of the baby automatically allows both the baby and the parent(s) to enroll in an individual/family health plan. It’s important to note that this does not cover prenatal (pregnancy) care or the cost of delivery.
Pennsylvania Medicaid for Pregnancy
Pennsylvania provides health care coverage for pregnant and uninsured people and children of low-income families (through age 18). Coverage for pregnant people can begin as soon as your doctor or nurse tells you that you are pregnant.
Your baby will automatically be covered (up to age one) if you are receiving Medicaid on your baby’s birth date.
To qualify for Medicaid pregnancy coverage as a pregnant person, your total family income must not be more than 215 percent of the Federal Poverty Level.
Applying for Medicaid
There is no open enrollment period for Medicaid, so if you are eligible, you can enroll at any time.
To apply for Medicaid pregnancy coverage, you can:
- Download an application form and send the completed form to your county assistance office.
- Talk to your doctor’s office, health clinic, or a qualified hospital. They may be able to help you fill out an application and complete a form that provides you with temporary eligibility.
- Apply online using COMPASS.
What if I Don’t Qualify for Medicaid While Pregnant?
If you are pregnant and uninsured, and you don’t qualify for Medicaid, you should consider plans on the federal Health Insurance Marketplace. These plans cover pregnancy and childbirth, even if your pregnancy began before you signed up for coverage.
Remember, the Open Enrollment for the Marketplace is November 1, 2024, to January 15, 2025, so you’ll need a qualifying life event to be eligible to enroll in coverage outside of this timeframe. If this is the case, you could apply for coverage now. When filling out the application, reporting your pregnancy can help you and your family get the most affordable coverage.
If you do not qualify for a Special Enrollment Period, you can apply for an individual/family health plan on the Marketplace within 60 days after your baby is born.
Get more information on Marketplace coverage.
Young Adult Coverage Under Parent’s Insurance Policy
Under the Affordable Care Act, young adults are allowed to stay on their parent’s group health plan until they are 26. To enroll, your parent should contact their employer.
Children’s Health Insurance Program
The Children’s Health Insurance Program (CHIP) is a federal program that provides health insurance to uninsured children. In some states, like Pennsylvania, it also provides coverage for pregnant and uninsured people. You can apply for and enroll in Medicaid or CHIP any time of year. There’s no specific enrollment period for either Medicaid or CHIP. If you qualify, your coverage can start immediately.
You can apply for CHIP online using COMPASS, Pennsylvania’s online application system. If you need any help using COMPASS, you can call the COMPASS Helpline at 1‑800‑692‑7462, option 7.
Other Resources for Pregnant and Uninsured People
Here are some additional resources for pregnant and uninsured people in Pennsylvania:
- Special Supplemental Nutrition Program for Women, Infant, and Children (WIC): This a federal program that supports low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk. The program provides healthy foods, nutrition education (including breastfeeding support), and health care referrals.
- Healthy Beginnings Plus: This is a Pennsylvania program that helps low-income, pregnant women who are eligible for Medicaid have a positive prenatal experience.
Give your baby the best start possible, starting with quality and affordable prenatal care. Learn more about the Independence Blue Cross plans available to you.
