Is Getting Pregnant A Qualifying Life Event?

Let’s face it: sometimes pregnancy is something you plan, and sometimes it’s not. Life is complicated—at all stages. That’s why we’re in the business of simplifying it.

Fact: getting pregnant without insurance can cost tens of thousands of dollars. The average cost of maternity care and delivery without complications is $23,000. With complications, that amount is a lot higher. Dealing with this without coverage is the type of stress no woman should have to face. But for about 13% of the 6 million+ women who get pregnant each year, these costs are all too real.

Usually, you’re only allowed to enroll in a health plan during the Open Enrollment Period. That is, unless you can point to a qualifying life event, which in turn triggers a 60-day Special Enrollment Period (SEP). Big events like marriage, divorce, and becoming a US citizen are all qualifying events.

We’ll cut right to the chase here: getting pregnant is not a qualifying life event. Unfortunately. Unless you’re in New York; they’re the only state that has added pregnancy as a qualifying event. Contrary to what many believe should be the case, a woman who finds out she’s pregnant — but doesn’t have coverage and wants pre-natal care — can’t sign-up for insurance outside of open enrollment in the rest of the country.

The good news: although being pregnant doesn’t qualify you for a SEP, giving birth (or adopting) does. You can enroll your newborn child or change your plan as soon as your baby’s born—even if it’s outside the Open Enrollment Period. With most plans, if you enroll by the 15th of the month, coverage begins the first day of the next month. But if you enroll with an SEP, coverage can begin on the day of birth, even if you enroll up to 60 days later.

If you already have health coverage, you can either keep your current plan and add your baby, or change plans altogether. Something to consider: maternity care and childbirth are essential services, and any legit plan covers them.

We know that growing your family is never stress-free, but we don’t think the focus should be on money. Need help deciding exactly what to do? Book an appointment with us today and we’ll help you pick the plan that’s right for you: now, 9 months from now, and long after that too.