An uninsured woman discovering that she is expecting probably feels the same pit-of-the-stomach feeling as a person would have after an uninsured auto accident. Let's face it — pregnancy care is expensive. According to central Texas United Healthcare Medical Director Dr. Harvey Balthaser, "Even an uncomplicated pregnancy that includes prenatal and inpatient delivery averages $7,600." And above all, expecting a child should be a joyous occasion.
There are not a lot of options out there to transfer the financial risk associated with an uninsured pregnancy to a health insurance policy. However, if a woman finds herself uninsured and pregnant, a few exceptions may exist.
One of those exceptions is an employer-sponsored health insurance plan. A Department of Labor law that dates back to the mid-1960s requires employers with more than 15 employees, and that sponsor health insurance plans, to provide maternity coverage.
Recommended For You
In 1996, Congress passed the Health Insurance Portability and Accountability Act. A part of that act no longer allowed pregnancy to be considered a pre-existing condition under any circumstance as it relates to employer-sponsored health insurance plans. If an expecting mother is not currently insured under her employer's plan because she thought it was too expensive, it is likely that she won't be able to enroll in that plan until the plan has its next "open enrollment period" or "anniversary." The only other way to be able to enroll outside of that time period would be to have a "qualifying event."
In some cases, the date of the open enrollment period is beyond that of the woman's delivery due date. If so, upon the date of her delivery, by giving birth to a child, she has had a family status change which allows her a 30-day window to enroll in her employer's health plan. When she does this, the effective date of the coverage will begin on the day of the qualifying event – the day of delivery.
Since most pregnancy related charges occur on that day, those claims can be submitted to the insurance company for their consideration of payments to the medical providers. However, any services that an expectant mother seeks prior to that day will not be eligible to be considered by the insurance company.
Conversely, if a pregnant woman has the opportunity to enroll in her employer's plan by way of the open enrollment period prior to her delivery date, she should take that opportunity to do so. By doing this, she is able to file claims on many pre-delivery, pregnancy related medical costs such as sonograms, pre-natal vitamins and other care.
If the expectant mother is unemployed or if her current employer doesn't offer a health plan with maternity benefits (employers with 15 or fewer employees may opt to sponsor a health plan that is void of maternity benefits), she may want to consider seeking employment from a company that does sponsor a health plan with maternity benefits.
Employer-sponsored coverage doesn't mean that prenatal care and delivery costs are inexpensive. Keep in mind that the employer is required to pay a very large amount of the premium on behalf of the employee. In most cases the employer is required to pay at least 75 percent of the premium. Many employers pay 100 percent. However, the employee may be required to pay the remainder of their premium. That could amount to a lot of money, but, without a doubt, it costs much less to pay that portion of the premium than to try to pay for all of the maternity charges out of pocket.
What is a pregnant, uninsured woman to do if she is unemployed or has no employer-sponsored health plan with maternity coverage? If obtaining maternity coverage through an employer or the father's insurance coverage is out of the question, it can be tricky or near impossible to obtain health insurance individually that will cover an already existing pregnancy outside the employer-sponsored realm of coverage.
Many states have Health Insurance Risk Pool Plans that may be utilized for coverage as a last resort. However, these plans may or may not include maternity benefits.
The only other options available for pregnant women caught without health insurance would be through other State or Federal welfare assistance programs such Medicaid. In order to qualify for those programs there are certain income and asset requirements. If a person or couple makes too much money they may not qualify. There may be other assistance programs offered through certain hospital groups and clinics, but none of these options are a good substitute for a good health insurance plan.
"In Texas, for example, the Health and Human Services Commission is charged with providing government-sponsored assistance for pregnant women who meet income and asset limits," Dr. Balthaser notes.
Dr. Balthaser adds that more and more hospitals are willing to negotiate payment rates and payback schedules for pregnant patients who have limited or no inpatient care insurance for delivery and newborn care.
If a woman finds herself pregnant and uninsured, the first place she should look to should be an insurance agent who is knowledgeable about the health insurance plans in her state and particularly an agent who is a member of the National Association of Health Underwriters. These agents know how to ask the right questions to determine her best and most prudent course in trying to obtain coverage and to determine if, indeed, coverage is available to her.
Kelly Fristoe, LUTCF, is secretary of the Texas Association of Health Underwriters.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
