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- Subscribers can switch plans during the open enrollment period
- After open enrollment period, switching needs an extension or exception
- Pregnancy is not a qualifying life event under the federal rules
- Childbirth is a qualifying event under the federal rules
- Life event coverage for childbirth relates back to the date of birth
Pregnancy is a time to make health insurance arrangements to add a child. Adding a child by birth or adoption can dramatically change health insurance needs. Pregnancy adds to the medical care requirements of mother and child. Prevention and wellness services include prenatal care.
Comparison shopping is an excellent method for finding the best insurance for an individual or family situation. Shoppers can use a feature such as pregnancy benefits to consider insurance options. Comparison shopping is an effective tool on and off the Obamacare marketplace.
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The Individual Mandate
The Affordable Care Act requires every eligible resident to get and keep qualified health insurance coverage. Those that fail or refuse to get coverage face the individual shared responsibility fee. The IRS applies this penalty on the basis of one-twelfth of the total for each month without insurance.
The plans sold on the Obamacare marketplace are qualified plans. This coverage satisfies the individual mandate and avoids the penalty tax. The tax for 2016 has the below-listed provisions. The IRS charges one-twelfth of the total for each month without insurance.
- The IRS computes the total by adding the sum of (1) and (2) up to the limit of (3)
- then taking the greater of the total or 2.5 percent of family income.
- (1) $695.00 per adult without insurance
- (2) $347.50 per child or minor without insurance
- Up to a family limit of (3) $2,085.00.
The Open Enrollment Period
Open enrollment period is the time to switch policies for pregnancy or any other reason. The open enrollment provides a right to buy insurance, and any eligible person can purchase, cancel, and replace a policy. The freedom of action during the open enrollment is in contrast to the time after it closes when no one can buy a qualified policy.
Policies purchased in the Obamacare marketplace offer premium tax credits, costs assistance and Health Savings Accounts, and costs reduction subsidies. Subscribers can only get these financial and cost benefits through the Obamacare Marketplace and state exchanges.
After Open Enrollment
The open enrollment for the calendar year 2016 began on November 1, 2015, and ended on January 31, 2016. Open enrollment for 2017 begins on November 1, 2016, and runs through January 31, 2017. Pregnancy outside of these dates would require an exception or an extension to permit enrollment.
Pregnancy does not create a right to enroll in the federal system. Childbirth does create a right to a special enrollment period. The childbirth exception also relates back to the date of the child’s birth. The coverage would begin with birth although not signed until afterward during the 60-day special enrollment period.
The federal government through healthcare.gov and the state governments through their respective exchanges can extend the time for enrollment. They can announce decisions to add additional days to the enrollment periods. They have done this in the past to accommodate applicants that started but did not complete applications.
States have used extensions to counteract delays and interference from storms, floods, and other unplanned events that interfered with sign ups in their territory. The extensions can be short periods of days or weeks. Comparison shopping can help applicants cut down on the time needed to find a great match of plans with their medical care needs.
After the open enrollment period, applicants can get a new 60-day period to select health insurance if they have a qualifying life event.
The life events are changes in status that require a new opportunity to buy insurance coverage. Status is not a permissible basis to treat applicants differently.
The Affordable Care Act recognizes only a few legitimate uses for status; the law allows the use of age, location, and tobacco usage. Pregnancy is not a status that insurers can use to charge more or to deny coverage.
The life events exception recognizes that some changes make insurance unworkable. Moving to a new location may take a subscriber out of the service area of their current policy.
They must have new insurance, or they will have no insurance coverage. Similarly, a pregnancy creates a need to cover a new beneficiary, a dependent, and new needs for prenatal, maternity, infant and post-natal care. The below-listed items are qualifying changes in status to support a special enrollment period under the federal rules.
- Adoption of a child
- Taking in a foster child
The New York Exception
The state of New York passed a law in 2016 that the Governor signed into law to establish pregnancy as a qualifying event for a special enrollment period. The New York healthcare exchange accepts pregnancy as a qualifying life event.
If outside of the open enrollment period, a pregnant woman can get a 60-day window to research and select health insurance coverage. She may switch policies or add first time coverage.
Earlier in the year, the federal government considered and did not pass a similar rule. Under the federal rules, childbirth is a qualifying event for a special enrollment period.
Changing Policies when Pregnant
Switching policies while pregnant may be the best way to adjust an individual or family insurance to a change in status. It is worthwhile to note that before the Affordable Care Act, insurers could deny coverage because of past or present pregnancy. They could also charge more for pregnancies.
Today, adding a child to the family by birth or adoption is simply a change in status.
It is a substantial change that requires a fresh assessment of health insurance. Pregnancy changes coverage needs and medical care priorities. Prevention and wellness services are important for the expectant woman as are prenatal health services and medical care. Obamacare provides maternity benefits and prenatal care as part of the essential health benefits. Comparison shopping is a great way to determine the policies that offer the best value and the lower costs.
Enter your zip below to compare multiple health insurance quotes and ensure your family’s coverage.
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