Health Coverage Options for Pregnant Women
Pregnancy is an important time for women to get the services they need as early in pregnancy as possible.
In California, there are several options for uninsured pregnant women to get health coverage. These options include Covered California health insurance plans and the following Medi-Cal programs:
Presumptive Eligibility for Pregnant Women is immediate and temporary coverage for low-income women who are pregnant and might be eligible for Medi-Cal. Coverage is available for up to 60 days while you apply for ongoing Medi-Cal. Presumptive Eligibility offers prenatal care and care related to pregnancy loss, as well as dental services. It does not cover labor and delivery or other hospitalization.
Full-scope Medi-Cal covers all medically necessary medical services, preventive services and dental services at no cost to eligible women. You must be a U.S. citizen or have a satisfactory immigration status to enroll in full-coverage Medi-Cal.
Pregnancy-related Medi-Cal covers all medically necessary pregnancy-related services for pregnant women who do not qualify for full-scope Medi-Cal. These services include prenatal care, labor, delivery, care after delivery, family planning services, care related to pregnancy loss and services for conditions that might complicate the pregnancy. Dental care and mental health services are also included.
Medi-Cal Access Program (MCAP) offers low-cost comprehensive coverage for pregnant women, with no copayments, deductibles or coinsurance, regardless of citizenship or immigration status. The program requires a fee of 1.5 percent of yearly family income that can be paid in monthly installments over 12 months. After your pregnancy and postpartum coverage with MCAP ends, you can transition to Covered California or Medi-Cal, depending on your household size, income, and immigration status at that time.
If your household income is too high to qualify for Medi-Cal, you may be eligible for a Covered California health plan with tax credits to help lower monthly premiums and out-of-pocket costs if you experience a Qualifying Life Event to apply.
When you apply through Covered California, your application is automatically checked to see if you are eligible for Medi-Cal, MCAP or Covered California.
How Medi-Cal Maternity Insurance Differs From Covered California
If you’re enrolled in a Medi-Cal managed care health plan, you pay little to no money for services you receive while pregnant. This differs slightly under the MCAP program. As a pregnant woman enrolled in MCAP, you receive comprehensive medical coverage without paying copayments or deductibles. Instead, you pay a one-time fee for services based on your income. The fee is calculated at 1.5 percent of your Modified Adjusted Gross Income. You can opt to pay your fee in a single installment or over the course of 12 months.
When you’re enrolled in a health care plan under Covered California, you pay a monthly premium for services, depending on your plan, as well as copayments and deductibles for office visits and other pre- and post-natal services.
Thanks to changes made to the Affordable Care Act, Medicaid maternity coverage is better than ever. Updates to the ACA requires all health plans, including those under California’s Medicaid program Medi-Cal, to provide the 10 essential health benefits everyone needs to live healthy lives. One of these benefits is maternity and newborn care. Now, mothers don’t have to worry about whether they have insurance for routine doctor visits, hospitalizations, tests or other pregnancy-related medical services.
Apply for MCAP Coverage Today
Pregnancy is a beautiful natural life event, but without health insurance and access to prenatal medical care, it can feel like a huge financial burden to new mothers and families — but it doesn’t have to be.
Our certified insurance agents are here to help pregnant women find the right maternity insurance plans for their needs. Let us help you find the perfect provider for your growing family. Get a free quote today by calling us today at (800) 650-0922.