The Special Enrollment Period For Pregnancy Isn't Offered Under Obamacare, But New Moms Have Some Leeway
Open enrollment under the Affordable Care Act, colloquially known as the Obamacare, ends on Friday, Dec. 15. However, there are exceptions that allow people with special life circumstances to still sign up, even after the deadline passes. For example, if you've just had a baby, there is a special enrollment period for Obamacare so you can make sure you're insured during that life-changing time.
Under the ACA, maternity and childbirth care are considered "essential" health benefits. This means that insurance plans certified under ACA are required to cover things like prenatal doctor visits, labor, delivery, postnatal treatment, and newborn care. If you didn't have health insurance during your pregnancy, the ACA allows a special enrollment period for you to sign up for insurance after you have given birth.
Officially, being pregnant is not be considered a "qualifying life event" that would trigger a special enrollment period under the ACA, but having a baby is. (So far, New York is the only state where pregnancy counts as a "qualifying life event.")
To apply for a special enrollment period, you must make an account at HealthCare.Gov, or else call the marketplace call center. In the case of childbirth, you must apply for coverage within 60 days of giving birth. Your health care coverage can start on the day you give birth even if you sign up any time during that 60-day enrollment period.
If you're not sure that coverage through the Marketplace, which is the official term for the Obamacare health care connector, is right for you, you may preview the projected costs of each plan based on your income. According to HealthCare.Gov, this is true during regular open enrollment as well as during special enrollment. (The Marketplace will also let you view private insurance plans, which are the alternative to government-subsidized plans.)
To do so, enter your zip code, age, estimated yearly income, gender, household size on the website. If you are potentially eligible for coverage under the ACA, or through Medicaid or the Children's Health Insurance Program (CHIP), the portal will let you know. You can then compare prices across a variety of plans, sorted by either the premium or the deductible. (If you live in one of the 11 states that have their own health care marketplace, however, the ACA website will link you to their respective connectors.)
Special enrollment periods are not just for people who are adding children to their households, either. People might be eligible for special enrollment if they have recently married, divorced, left prison, if someone on their marketplace plan died, moved outside of their zip code, or if they are moving between a shelter and other transitional housing. Additionally, a person may be eligible for a special enrollment period if they have lost health care coverage in the last 60 days, or expect to in the next two months.
Essentially, special enrollment periods function as a way to allow those who missed the open enrollment period to still sign up if they can justify their need. But if it feels like the 2018 open enrollment period flew by, that's because it was half as long as in years past. Before 2017, there was a three-month window during which anyone eligible for Obamacare could sign up for it. There was also extensive advertising about the open enrollment dates, encouraging folks to register.
This year, open enrollment was cut down to just six weeks and the advertising budget was slashed by a projected 90 percent. In October, according to The Hill, President Trump, who campaigned on ending the ACA, told members in his cabinet that "Obamacare is finished. It's dead. It's gone."
"You shouldn't even mention it, it's gone," Trump said. "There is no such thing as ObamaCare anymore. It is a — and I said this years ago — it's a concept that couldn't have worked."
Despite moves to hamper the enrollment process, millions of American have reportedly signed up for health care coverage through the Marketplace, which serves 39 states.The Los Angeles Times reports that, as of last week, 4.7 million American signed up for coverage this go-round. Additionally, enrollment rates are reportedly up by about 17 percent.
The language surrounding health care can be confusing, but the ACA website makes clear that having a baby makes anyone, currently a plan policy holder or not, eligible to enroll in Obamacare. This means that if you are pregnant and missed open enrollment, there is still a chance that you can get covered.