Being pregnant amid a global health crisis is terrifying as is. Even more so is the prospect of also losing insurance while pregnant — which is exactly what happened to millions of people over the course of the pandemic.
Leah Morales, an operations manager in New York City, is one of those people. She had just found out she was pregnant when the pandemic took a terrible toll on her company, by whom she was previously insured. “We were told they could no longer insure us, and had to cut all full-time employees’ salaries and hours more than half,” she says. “So here I was, newly pregnant and uninsured.” (And having just taken a pay-cut.)
Morales spent a month without insurance, eventually applying for Medicaid via New York State. What she didn’t realize, however, was that there are limited options in terms of clinics, hospitals and doctors who accept Medicaid.
Finding care that takes Medicaid
“Mentally, it took a huge toll on me — it was difficult finding hospitals that accepted my new insurance,” Morales recalls. “I cried everyday until I finally found a clinic that would take me at 16 weeks. That’s three months of trying to find care!”
This was an especially frightening time for Morales in particular: She had been pregnant in the past, but the first pregnancy wasn’t viable, resulting in a dilation and curettage (D&C). As a result, doctors said she would have difficulty getting, and staying, pregnant.
“Being uninsured and not being able to find a hospital right away when I did find out I was pregnant — to make sure I could carry to full term — was frustrating,” she says. “How can we live in a country that cares so much about life, but finding a doctor that takes your insurance [is] so difficult?”
“That’s when I realized pregnancy is a luxury.”
Imani Francies, an Atlanta based content writer for USInsuranceAgents.com, also began her pregnancy uninsured. She had just resigned from her job as a full-time teacher, and coverage ended 30 days after her last day on the job.
“At first, we were going to finance with a midwife who would monitor my pregnancy and help me deliver the baby in my home, but ultimately decided it would be safer for me to deliver in a hospital because of my first daughter being delivered through C-section,” she says. “We ended up acquiring insurance with Georgia pregnancy Medicaid so I can deliver in a hospital without paying too much out of pocket.”
“That’s when I realized pregnancy is a luxury.”
Like Morales, she too had to extensively research to find prenatal healthcare covered by Medicaid, only finding an OBGYN who accepted her insurance an hour away. “Having to drive an hour to go to my appointments can be taxing,” she admits. “It should be possible to find quality medical care nearby without the restraints of insurance acceptance interfering. Also, patients having to pay for parking is an expense that adds up, but many people do not take it into account.”
The real cost of giving birth
Morales and Francies, who are both due next month, are unsure how much their co-pay will be for giving birth — mostly because there isn’t an exact way to calculate it in advance. Morales is trying not to worry about it, ready to manage whatever comes her way.
“I am prepared for what my bill may look like this time around,” Francies concurs, but adds that regardless, births are unnecessarily expensive for expectant mothers.
“Delivering a baby should be affordable without insurance and with pre-existing conditions,” she continues. And without unexpected excess costs, at that. With Francies’ first pregnancy, there were unexpected complications resulting in an emergency C-Section. After reviewing the bill, she noticed she’d been charged to hold her daughter after she was delivered. “Instances like that seem unfair and uncalled for,” she adds.
A University of Michigan study found that in 2015, which was the most recent data available, the average cost of giving birth in the U.S. was $4,500 — regardless of whether or not the patient has insurance. According to more recent data from Fair Health, however, the average cost of in hospital delivery falls between $5,000 and $11,000 in most states.
Considering the high price point — with or without insurance, and certainly greater without — the number of Americans who have recently lost insurance, which can at the very least alleviate some of the steeper prices of pregnancy, is cause for concern.
As of June 2020, the pandemic-induced recession was estimated to be responsible for an estimated 7.7 million workers — and 6.9 million dependents — having lost their employee-sponsored health insurance. This totals to approximately 14.6 million individuals left without coverage, according to a study by The Commonwealth Fund.
By definition, this left a large percentage of pregnant people without insurance, as well.
What happens when a pregnant person loses insurance?
“The biggest risk [to uninsured pregnancy] is delaying or avoiding care,” says Talitha Phillips, CEO of Claris Health and certified labor and postpartum doula in Los Angeles. “There are important prenatal visits and tests that someone may miss if they don’t have the proper insurance, or have difficulty navigating the insurance system.”
Considering the rising rate of maternal and pregnancy-related deaths in the country — especially for women of color — this can be especially dangerous. “CDC notes that 60 percent of these deaths could have been prevented had the mothers understood and accessed quality prenatal and postpartum care,” Dr. Nancy Nielsen, senior associate dean for health policy at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, told SheKnows. “Getting regular health care, with treatment for conditions that can cause complications is critical, and it won’t happen if the mom is uninsured.”
Such was the case for Brianna Edwards of California, who lost her insurance when her husband was laid off. At the time, she was four months pregnant. “My doctor’s office would not see me unless I paid the full price upfront for the rest of my prenatal care — which was $3,000. We simply could not afford it,” she says. “It was the same story at every OB[GYN] around me, so I applied for MediCal and was given the run-around for three months.”
When she finally acquired insurance and was able to return to the doctor at seven months pregnant, “they discovered complications that could have been discovered months prior. It was absolutely ridiculous.”
It’s to be expected, then, that losing insurance while pregnant can negatively impact mental health, as well. “The stress of being uninsured or financially unstable is not good for the mom or baby,” Phillips adds — especially when it comes to switching insurance. “Navigating insurance options can be very challenging. It can be confusing, labor-intensive, and stressful.” None of which are terms one hopes to associate with pregnancy.
Still, at least one-third of newly pregnant people will experience some type of insurance transition during their pregnancy, according to Sarah Michalczuk, Founder & CEO of predictaBill, which specializes in unbiased health insurance advice.
“Pregnancies are nine to 10 months, and nearly all Americans must re-opt into their health insurance once every twelve, so it’s not surprising that individuals who are in some type of transition may lose coverage by accident,” Michalczuk says of the seemingly high number. “There are [also] some very esoteric situations where it may be difficult for pregnant women to maintain coverage, [like] those with coverage through a union.”
One example is the actor’s union, SAG-AFTRA, for which you must earn a minimum dollar amount through acting or work a minimum number of days to qualify for insurance. “You can imagine that a person who is pregnant may have trouble finding acting work during her pregnancy,” Michalczuk says.
On the other hand, some people may intentionally opt out of insurance because they think it’s cheaper, or don’t realize they’re eligible. “It’s not unusual for a couple to be insured through a short-term medical plan that seems cheap, however, once they become pregnant, they realize it specifically excludes maternity coverage,” she explains. “Another reason is simply around education. There is a misperception that you won’t be able to get health insurance if you are pregnant or that it will be more expensive. In fact, the opposite is true.”
I’m pregnant: Do I qualify?
“You may be eligible for cheaper insurance because you are pregnant,” Michalczuk clarifies. “If your income is low, you will qualify for subsidies — discounts — on insurance premiums, and you may even get extra discounts specifically because you are pregnant. These insurance plans cover prenatal care completely — [meaning it’s] free for you — as long as your OB/GYN sticks to services that are considered preventive by the U.S. government. In other words, a set number of ultrasounds and very specific bloodwork.”
If you are uninsured and unsure for which insurance you qualify, Michalczuk suggests checking healthcare.gov for subsidies (your discounts), or to see if you qualify for Medicaid. Alternatively, if you have private health insurance, you can use PredictaBill.com to have its algorithm compare potential plans. “There is almost always an opportunity to save thousands of dollars, but it may not be obvious how to do it,” she says, also suggesting that if your or your spouse’s Open Enrollment period is before your due-date, it’s wise to reconsider your options now.
“The vast majority of medical bills will hit the day your baby is born,” she explains, adding that post-birth, parents only have 30 days to add their newborn to their insurance plans. “Make sure to add your baby to your health insurance as soon as possible,” she advises, acknowledging that it’s hard to remember to do so when caring for a newborn. “If you and your spouse are on separate plans, you can add your baby to either plan. You will likely need a copy of the birth certificate in order to do this, so plan accordingly.”
If you are pregnant and recently lost insurance, don’t panic. “The government mandates that prenatal care is free — you don’t have to hit a deductible — with your health insurance,” says Michalczuk. “They want to encourage more mothers to receive prenatal care and have healthy births.”
That said, there are still costs that may remain uncovered. “State insurance won’t cover certain tests because they aren’t deemed necessary,” Morales explains, citing her own experience. “I personally feel that NIPT [Noninvasive prenatal testing] is necessary. It gives the parent time to plan how to take care of their child who might have a disability, or terminate before 20 weeks. Since it isn’t covered, [I suggest you] have an extra $250 to $400 saved for that test”
“Also, scans can range from $300 to $600,” she adds. “I learned the hard way.”
Morales suggests one thing above all, however: Seeking support in the pregnant and parenting community. “Sign up for all the apps and forums,” she insists. “I met amazing ladies on pregnancy apps who had given birth here in New York on Medicaid. [They] guided me to a clinic that might be able to fit me in — and they did!”
Francies concurs, and advises looking into free healthcare services and organizations in your area. “Start researching online to see what help is available nearby,” she says. “Planned Parenthood, community health centers, Medicaid, and the local health department are good places to start.”
Before you go, check out our essentials for people pregnant on bed rest: