The importance of proper health care during pregnancy is something Covered California takes very seriously and has made a priority. That’s why the state-based health insurance exchange has fixed an enrollment gap for middle-income uninsured pregnant women.
According to the recent “fix”, which came about this October ahead of the November 1st launch of Open Enrollment 2016, the exchange provides qualifying women with more affordable benefit options.
Until changes were made, Covered California did not have the option – as required by the Affordable Care Act – which requires that pregnant women be screened for the Medi-Cal Access Program (formerly known as Access for Infants and Mothers) eligibility as well as being provided with information about the optional coverage so they can choose from less expensive programs before enrolling in a more costly health plan through the health exchange.
Depending on income, citizenship, and immigration status, women who meet the requirements of MCAP can be eligible for premiums that are only 1.5 % of their income or approximately $42 to $64 per month. In addition, under the MCAP program there are no co-payments, deductibles or other fees – and, no need for co-insurance.
Currently, enrollment options as offered by Covered California health insurance plans and Medi-Cal (the state’s version of Medicaid) include:
• Presumptive Eligibility for Pregnant Women – entitles temporary coverage up to 60 days. • Full-coverage Medi-Cal – coverage at no-cost. • Pregnancy-related Medi-Cal – coverage at no-cost. • Medi-Cal Access Program – coverage at low-cost.
While the Covered California open enrollment period for 2016 runs only three months from November 1, 2015 to January 31, 2016, MCAP offers women in need of health insurance year-round enrollment. Unfortunately, if you fail to participate in or miss the open enrollment period, pregnancy is not considered a “qualifying life event” for special enrollment in Covered California. However, once the child is born, women can enroll themselves and their newborn for coverage.
However, keep in mind that you could be subject to a penalty for not having health insurance. The best way to avoid the fine is by taking advantage of the open enrollment period or applying for MCAP.
In certain cases, you may, in fact, meet the eligibility requirements for both Medi-Cal and Covered California during the course of your pregnancy and immediate postpartum. But, this will depend once again on your income, citizenship, and immigration status.
When applying for health insurance coverage during the Covered California open enrollment period, your application will also be sent to Medi-Cal in the county you reside in. And, although you may actually qualify for both programs, you might want to choose the one that best meets your insurance needs.
Pregnant women, who aren’t covered by adequate health insurance and aren’t receiving necessary prenatal care because they can’t afford it, are putting their own health as well as the health of their babies at risk. According to statistics, babies born to mothers who haven’t gotten proper prenatal care have a three times greater chance of low birth weight and are five times more likely to die, compared to babies whose mothers were under a doctor’s care.
Covered California and MCAP want all women without health insurance to find the coverage that will provide them and their unborn or newborn child with affordable health care. And, for that reason – they’ve made it a priority.