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    Can You Switch Health Insurance While Pregnant?

    5 mins

    Can you switch health insurance when pregnant? Yes, you certainly can, but only if it’s during the open enrollment period (the open enrollment period will depend on if you have an individual plan or get insurance through a group plan).

    If you want to change insurances outside of the open enrollment period, you’d need to experience a qualifying life event in order to do so (pregnancy is not considered a qualifying life event).

    Examples of qualifying life events include:

    • There’s a change in your legal marital status (you get married or have a divorce)

    • Your spouse passes away

    • There’s a change in the number of dependents you have (you give birth to a child or adopt a child)

    • You or your spouse have a change in employment status (leaving a job or starting a new job, for example)

    • You move to a new address that’s in a different zip code or county that no longer allows for access to in-network providers

    • You turn 26 and no longer have coverage from the insurance of your parents

    • You no longer qualify for Medicaid, Medicare, or Children’s Health Insurance Program (CHIP)

    • You become a citizen of the US

    If you do experience a qualifying life event while you’re pregnant and qualify for a special enrollment period, make sure to let your insurance know as soon as the event happens, as you typically will have up to 30 days to enroll in your new plan.

    You also may be asked for documentation related to your qualifying life event, so make sure you have those ready to go in order to avoid delays.

    Benefits of Switching

    If you meet the criteria for switching, there are several potential benefits to switching health insurance while pregnant. First, you may be able to find a plan that better meets your needs. Perhaps your current plan doesn't cover maternity benefits or has a high deductible. If this is the case, going with a new plan could save you a lot of money.

    Additionally, you may be able to find a plan with a lower premium. This setup can be especially helpful if you're currently on an individual or family plan and are looking to switch to a group plan through your (or your spouse’s) workplace. 

    Group plans, offered through an employer, tend to have lower premiums than individual plans, saving you a significant amount each month.

    Another potential benefit of switching is that you may be able to find a plan with a better network of doctors and hospitals. If you're unhappy with your current provider, moving to a new plan could give you access to the care you want and need.

    Moreover, if you're worried about your current coverage, switching to a new plan can put your mind at ease while helping you avoid any stressful surprises down the road.

    Consider the ACA Rules

    If you're currently covered by an individual plan offered through your state or federal healthcare exchange under the Affordable Care Act (ACA), there are a few things to remember when switching health insurance.

    First, you can only change during the open enrollment period, which runs from November 1st to December 15th each year. If you miss out on this window, you'll have to wait until the following year to change your coverage.

    Second, if you're switching to a new plan, you'll need to ensure it meets the same requirements as your old plan, including offering essential health benefits that the ACA stipulates, such as:

    • Ambulatory patient services

    • Mental health services

    • Substance use disorder services

    • Chronic disease management

    • Hospitalization

    • Rehabilitative and habilitative services and devices

    • Prescription drugs

    • Laboratory services

    • Emergency services

    • Maternity and newborn care

    • Preventive and wellness services

    • Pediatric services

    If you're unsure whether your new plan meets these requirements, check with your insurer. Otherwise, you may be subject to a tax penalty and could end up without the coverage you need.

    Finally, remember that you may receive a premium tax credit if you switch to a new ACA plan. This credit is based on your income and can help lower the cost of your monthly premiums.

    If you're eligible for a premium tax credit, make sure to talk to your insurance company or an expert before making your switch. 

    Additional Things to Consider Before Switching

    There are a few things to consider before you switch health insurance while pregnant. First, ensure that your new plan covers maternity benefits. Otherwise, you could end up paying for your entire pregnancy out-of-pocket.

    Additionally, you'll want to consider the various costs of switching plans and factor in the cost of any new deductibles or copays.

    Lastly, you'll need to decide whether you want to keep your current doctor or switch to a new one. If you have a great relationship with your current doctor, it may be worth staying with them. 

    However, switching may make sense if you're considering working with a new doctor who is considered in-network by your new insurance plan.

    Bottom Line: Can You Switch Insurance While Pregnant?

    While changing health insurance while pregnant is possible, it's important to remember that you need to do it within the open enrollment period of your state (if on an individual plan) or job (if you’re on a group plan). The only way you can switch health insurance outside of open enrollment is if you experience a qualifying life event (which doesn’t include pregnancy).

    Whatever you decide, practice due diligence and ask plenty of questions. That’s the best way to ensure you make the ideal decision for your health and your wallet.

    Kristina Dinabourgski
    Kristina Dinabourgski
    Has a passion for demystifying benefits 🎉
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