Open Enrollment: Information for Families and Expectant Mothers

Sasiistock / Getty Images

Of all the purchases you make for your family, health insurance could be the most important. Since the average American family cannot afford to pay out of pocket for the medical expenses they incur, health insurance is an important way to manage the cost of healthcare. In the United States, there are multiple ways to obtain health insurance though not every family is eligible for every plan. Some obtain health insurance through their employer. Others through a government program like Medicare, for example.

For those ineligible for other plans, obtaining a plan through the Health Insurance Marketplace during open enrollment is a good option.

Open Enrollment for the Health Insurance Marketplace runs from November 1st and ends December 15th. If you are an expectant mother, obtaining health insurance before birth is a crucial step toward ensuring you and your baby receive affordable, adequate medical care before and after birth.

What Is The Health Insurance Marketplace?

The Health Insurance Marketplace is a coverage option created under the Affordable Care Act that permits people to buy health insurance on their own and to choose the plan that best meets their needs. It’s also sometimes called a Health Insurance Exchange.

Why Purchase Insurance Through The Health Insurance Marketplace?

If you are ineligible for other insurance plans and are in need of health insurance, the Health Insurance Marketplace (“the Marketplace”) is a good option for you. In previous years, enrolling in a plan also prevented a “shared responsibility” fee from being assessed against individuals without minimum essential health coverage. However, as of January 2019, that fee no longer applies.

Who is Eligible to Purchase Insurance through the Marketplace?

To be eligible to enroll in health coverage through the Marketplace, you:

  • Must live in the United States.
  • Must be a U.S. citizen or national (or be lawfully present).
  • Can’t be incarcerated.

If you have Medicare coverage, you are ineligible to use the Marketplace to buy a health or dental plan.

When Does Enrollment Start?

To enroll in an insurance plan through the Marketplace, you must do so during the Marketplace’s open enrollment period. For 2019 coverage, open enrollment lasts from November 1, 2018 to December 15, 2018. Coverage begins January 1, 2019.

Depending on your income, you may qualify for an insurance plan with tax credits or for Medicaid/Children’s Health Insurance Program (CHIP). Healthcare.gov provides helpful tools to can determine where your income falls. You can also preview available plans and estimated prices based on income on the site.

Open Enrollment for Families and Expectant Mothers

Families and pregnant women need certain services that, for example, a healthy person without children would not. All plans available through the Marketplace cover essential health benefits, pre-existing conditions, and preventive services. This is good news for families who may have been ineligible for insurance under other plans. The essential health benefits in particular offer services crucial to expectant women, children, and families.

Essential Health Benefits

Every Marketplace health plan must cover several essential services. These include services crucial to expectant women and families among others: emergency services; hospitalization; pregnancy, maternity, and newborn care (both before and after birth); prescription drugs; preventive and wellness services and chronic disease management; pediatric services; including oral and vision care; birth control coverage, and breastfeeding support coverage.

Additional information regarding pregnancy, maternity, and newborn care can be found at the links provided above. Information may also be found by visiting the Essential Health Benefits page on Healthcare.gov.

Pre-Existing Conditions

Under the ACA, pre-existing conditions—including pregnancy—are covered. This means that if you are currently pregnant, you will still be eligible for coverage for a plan that begins on January 1st.

This also means that an insurance plan can’t reject you or charge you more because of your pregnancy.

Special Enrollment Periods

Your child’s birth or adoption qualifies you for a Special Enrollment Period. This means you can enroll in or change plans outside the annual Open Enrollment Period. Your coverage can start from the date of birth or adoption, even if you enroll up to 60 days afterward.

Preventive Services

Every Marketplace plan covers preventive services. These include services important to women and children.  This care provides several important screenings to pregnant women, including for preeclampsia, anemia, and gestational diabetes.

Preventive screenings for children include Bilirubin concentration screening for newborns, blood and hearing screenings for newborns, and many more services.

Obtaining health insurance coverage during open enrollment for families through The Health Insurance Marketplace can be an important step toward ensuring your family gets a healthy start in the new year.

Additional information can be found by visiting the Healthcare.gov Contact page.

 

Read more about healthcare for your family