Part I: Pregnant and Uninsured

Dear Cheasty,

My friend just found out she's pregnant. She and her husband each own small businesses (she’s a massage therapist and he’s an artist), and they don’t have health insurance. When she tried to buy health insurance for her pregnancy she found she couldn’t because being pregnant is considered a pre-existing condition. So then he tried to buy insurance, but they wouldn’t let him do it either, because he’s an expectant father and I guess that’s a pre-existing condition, too. I know that the health reform has some things in it that will help them out, but can you tell me what they are so I can tell them?

Thanks, A Concerned Friend

Dear Concerned,

Wow, pregnant AND uninsured. That’s a stressful situation to be in. Given how expensive individual health insurance policies are, I can understand making that decision and taking the risk. But, even if your friend weren’t pregnant, in today’s market she should know it would be near impossible to purchase an individual policy that covered maternity benefits (unless she purchased a “maternity rider” which is so expensive it isn’t even insurance – it’s essentially paying for maternity care at full price). In sum, even if she had purchased insurance, she’d probably be in the same pickle anyway regarding the upcoming baby.

The thing to note, however, is that the full implementation of the Affordable Care Act (ACA) in 2014 will address your friends’ predicament in two ways. The first has to do with coverage for pre-existing conditions, and the second has to do with something called Essential Health Benefits, which I'll cover in more detail in a separate post.

Both will be vital to making sure that none of us ever finds ourselves in your friend’s predicament again.

For now, please tell your friend she can apply today for the Federal Pre-Existing Condition Insurance Plan (PCIP), which provides insurance to people currently excluded from coverage until 2014. Since pregnancy qualifies in the insurance world as a pre-existing condition your friend may be eligible for health insurance after all!

Please check out one of my earlier posts detailing the PCIP,here.

The most important take-away about pre-existing conditions is this: Beginning January 1, 2014, NOBODY, EVER AGAIN, will be denied or up-charged for a pre-existing condition, no matter what that condition is. In other words, if we were having this conversation two years from now, well… we wouldn’t be having this conversation at all!

The other great piece of news for people who don’t get insurance through their employer and instead have to buy their insurance on the individual market, is a part of the ACA that requires ALL insurance policies to cover a set of ten Essential Health Benefits, including maternity services. For more about these Essential Health Benefits, click here.

Concerned, I hope this initial post helps to take away at least some of the worry for your friends.

To a well and healthy Texas, Cheasty