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Health Care Reform:

Health Insurance & Affordable Care Act

Insurance When You're Pregnant: FAQ

Am I eligible for Medicaid while I'm pregnant? continued...

After your Medicaid pregnancy coverage ends, you may still have other insurance options through your state or a private company. If your Medicaid coverage ends, you can qualify for a special enrollment period to shop and buy a health plan through your state’s Marketplace, even if it is outside the annual open enrollment period.

The Affordable Care Act gives states new opportunities to expand their Medicaid programs to cover individuals who earn up to 138% of the federal poverty level (just over $16,000 per year for an individual in 2014). Not all states have done this. See the Source Box for a link to check your state’s status. If your state has expanded the program and you meet the income and other eligibility criteria (for example, you are a resident of the state in which you are applying), you will still be covered under Medicaid.

What questions should I ask before choosing a health plan to cover my pregnancy?

Ask how much your deductible will be. In general, your deductible goes down as your monthly premium payments go up. Also, take the time to understand other out-of-pocket costs that come with your plan, such as copays and coinsurance.

Ask which providers are in your plan’s network. You'll want to know which obstetricians, hospitals, and pediatricians participate in the plan. Your plan may only cover preventive services received from in-network providers.

Ask to see the full summary of benefits and look it over closely. Pay close attention to any specific services you want or need to make sure they are covered by your health plan.

Once your baby is born, you qualify for the special enrollment period through the Marketplace. You may be eligible for more coverage for new parents.

What happens after my baby is born?

You need to get in touch with your employer, insurance company, or state Marketplace to add a child to your health plan shortly after you give birth. Many employers require you to add your baby to your policy within 30 days. Having a baby qualifies you for a special open enrollment period in your state’s Marketplace and allows you 60 days to choose a plan for your baby or make changes to your existing plan. Depending on your income, your child may qualify for Medicaid or CHIP even if you have a policy through your employer or state Marketplace.

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