Pregnant with no health insurance...

November 21, 2007 6:58 AM

We found out my wife was pregnant the day before I lost my job. I was working for a non-profit whose healthcare coverage is self-funded and somehow they are exempt from having to offer COBRA.

I've got plenty of freelance work to keep me busy and pay the bills, however we can't find a solution for insurance coverage for the pregnancy. The bill from her first pregnancy was $25k+ and there's no way we can handle that out-of-pocket, nor the risk of other complications, etc.

If it's the only solution, I'm willing to get a part-time job somewhere that offers health insurance to p/t employees (i.e. Starbucks) or even forgo the free-lance route and pursue another full-time job. However, either of those will still mean a lapse in coverage, perhaps as long as 90 days in the case of a p/t job. Any ideas/suggestions?

posted by anonymous to health & fitness (22 comments total)

With a new full time job you may be able to negotiate that your health plan starts up immediately. It's been done before. An employer who wants you will certainly do that especially given the circumstances.
posted by zackola at 7:08 AM on November 21, 2007

Many states have insurance coverage options for pregnant women. I don't know if income guidelines apply, but check it out.
posted by necessitas at 7:11 AM on November 21, 2007

Many municipalities have health pregnancy programs as well. Check with your city health authorities.
posted by zia at 7:16 AM on November 21, 2007

If you don't live in a big city, the country health board does the same role as the above answer.
posted by unixrat at 7:17 AM on November 21, 2007

It's very hard to answer this question without knowing what state you live in. You can ask one of the site ops to post that for you through a link on the anon question page.

As far as a lapse in coverage, I believe that this shouldn't be a problem as long as you get new coverage within 60 days. But that could vary by state, so there you go.
posted by alms at 7:23 AM on November 21, 2007

In New York City I see ads for freelance health insurance all the time. I'm not sure if it's good or affordable, but you could check a site like mediabistro.com to see if they have more information. It definitely seems doable.
posted by sweetkid at 7:27 AM on November 21, 2007

I assume the reason they're exempt from COBRA is that they have fewer than 20 employees. Often, the state you live in will have legislation in place providing a COBRA-like extension for firms of 2-19 employees. Your employer might not know about this (more common than you would think with small employers).
posted by MarkAnd at 7:29 AM on November 21, 2007 [1 favorite]

In the US there are scads of public health and private
"public" services dedicated to healthy pregnancy and birth for women who have no health insurance. Your and your wife should first call her previous obstetrician and ask what she would suggest. Then call your local Health and Human Services Department. Without knowing at least what state you're in, it's going to be hard for anyone here to give you better guidance. Medicaid. WIC and the Maternal and Child Health Bureau might also be good places to start looking.

You probably know all about public health services and it may be the unwritten part of your question that you don't want your wife to have to go through pregnancy without private insurance. I have absolutely no idea how you can go about finding, affording or getting private health insurance for your wife with no gap. I had self-funded insurance with Blue Cross Blue Shield for a while. It was horribly expensive and I did not opt for the maternity coverage, which would have made it even more expensive.
posted by crush-onastick at 7:36 AM on November 21, 2007

Many insurance companies will let you continue your group policy as a private pay. Typically this has to happen within a certain time frame from when you become ineligible to be a member of the group.
posted by HuronBob at 7:37 AM on November 21, 2007

Also, $25K seems like a lot for an uncomplicated pregnancy.

Of course, if her first pregnancy had complications, don't bother to read what I'm about to say next.

For most women under 35, the vast majority of testing and whatnot that is done is an expensive way to cover the doctor's butt. If she's comfortable with it, I'd suggest looking into using a midwife and/or a birth center rather than an OB/GYN and hospitalization, which can reduce the cost of the birth by a lot. When my son was born, my primary care came from a midwife practice, and he was born at a freestanding birth center (a medical facility not attached to a hospital that does births only). Despite the fact I had three ultrasounds and two office visits with a neonatal specialist (I had a borderline diagnosis of gestational diabetes) the entire bill for his birth was around $7000.00. This does not mean the level of care I received was any less than I would have with an OB - in fact, I felt my care was much more personalized. However, the midwife's practice and the birth center have much lower overhead than the OB/Hospital and so can charge much lower fees.
posted by anastasiav at 7:51 AM on November 21, 2007

As far as a lapse in coverage, I believe that this shouldn't be a problem as long as you get new coverage within 60 days.
That only applies if you are moving between group plans. If you are moving from a group plan to a private plan, the new insurer is not required to cover pre-existing conditions...like pregnancy.
posted by Thorzdad at 7:51 AM on November 21, 2007

Your state has an insurance commission and an attorney general. Consumer affairs are usually in the AG's office. They are the experts on this. The numbers will be in the deadtree edition of the phonebook, under your state. Call them.
posted by theora55 at 7:56 AM on November 21, 2007

See if you qualify for WIC.
posted by cass at 8:23 AM on November 21, 2007

I know, at least in NY, the state offers health care to pretty much any pregnant woman who asks. We also have a lot of options for children's insurance.

Nationwide, planned parenthood works on a silding scale based on income and does prenatal care.

Although neither may be an ideal long-term solution, since that kid's going to need insurance once it's here and most children's insurance programs are income based (so a freelancer may make too much to qualify), it should get you through for now.
posted by Kellydamnit at 8:33 AM on November 21, 2007

I 2nd WIC, although that does nothing for insurance for the pregnancy. The pregnancy is going to be classified as a "pre existing" no matter what you do. Yes, health insurance is great and you should find a private plan, but I'm willing to put big money on the fact that they will not cover the pregnancy.

Call your Department of Health, Planned Parenthood, local hospital and see if they can head you into the right direction as far as being pregnancy without health insurance. They very likely have resources to refer you to.

And, Congratulations!!!!!!
posted by 6:1 at 8:48 AM on November 21, 2007

//As far as a lapse in coverage, I believe that this shouldn't be a problem as long as you get new coverage within 60 days.
That only applies if you are moving between group plans. If you are moving from a group plan to a private plan, the new insurer is not required to cover pre-existing conditions...like pregnancy.//

I don't think that is correct. I've gone from a group plan to a private plan twice, and both times had no issue with my diabetic wife being covered from day 1. They may be an exclusion specific to pregnancy, but I don't think so. They key is that you only have 60 days from when your group coverage lapses.

Also, would your previous employer maintain you on insurance if you foot the bill? I've been made that offer by small employers in the past. If you left on good terms they may be open to it.
posted by COD at 8:58 AM on November 21, 2007

Also, $25K seems like a lot for an uncomplicated pregnancy.


An uncomplicated C-section can run you 35-40K without insurance. It'd be cheaper to move to Great Britain for the final two months of the pregnancy.
posted by mattbucher at 9:08 AM on November 21, 2007 [1 favorite]

From the WIC guidelines:

The WIC Program is designed to serve certain categories of women, infants, and children. Therefore, the following individuals are considered categorically eligible for WIC:
Women -- pregnant (during pregnancy and up to 6 weeks after the birth of an infant or the end of the pregnancy)
-- postpartum (up to six months after the birth of the infant or the end of the pregnancy)
-- breastfeeding (up to the infant's first birthday)

So, WIC is categorically designed for pregnant women. This particular family may not be eligible because it does have an income threshhold.
posted by crush-onastick at 9:28 AM on November 21, 2007

It'd be cheaper to move to Great Britain for the final two months of the pregnancy.

You could also move to Massachusetts, which now essentially has universal health insurance. (You have to buy it, but there you are guaranteed to have something to buy, i.e. insurers can't exclude you and can't exclude preexisting conditions.)
posted by alms at 9:44 AM on November 21, 2007 [2 favorites]

I agree with everyone who said that there are a lot of programs out there for pregnant women. Most states pretty much guarantee that for pregnant women plus babies. When the kid is born, look into SCHIPs.
posted by fructose at 12:04 PM on November 21, 2007

*that is State Sponsored Children's Health Insurance Programs
posted by fructose at 12:05 PM on November 21, 2007

Is she unable to work herself for some reason? I realize that employers aren't fond of people who get a job and then start showing signs of pregnancy shortly thereafter, but it's not illegal.
posted by groovinkim at 6:18 PM on November 21, 2007