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Special Enrollment Is Here, But Pregnancy Isn’t A Qualifying Event To Get Covered

This post originally appeared on Enroll America’s blog.

By Christina Postolowski

This week, The New Yorker profiled what has increasingly become a high-profile campaign to make maternity coverage accessible to pregnant women year-round.

February 15 marked the close of open enrollment and the start of “Special Enrollment.” The Department of Health and Human Services (HHS) marked the occasion by finalizing several new qualifying events that will allow people to get covered outside of open enrollment, but pregnancy is not one of them.

Since last year, Young Invincibles and several other groups have been urging HHS to create a Special Enrollment Period (SEP) for pregnant women who lack access to maternity coverage. Without maternity coverage, pregnant women may be forced to delay or forego needed care, which can lead to dire health and financial consequences. HHS recently reported that the average hospital bill for childbirth costs over $23,000. Maternal mortality is three to four times higher among women who receive no prenatal care compared to women who do.


While pregnant women can get covered under Medicaid or the Children’s Health Insurance Program — a great resource for those that are eligible — not all women have access to this program. A woman who is just above the income eligibility threshold for Medicaid in her state and finds out she is pregnant outside of the marketplace open enrollment period will likely not have access to coverage.

Additionally, although the Affordable Care Act has expanded access to maternity coverage — by requiring most health plans in the individual market to cover maternity care as an essential health benefit — there are still some plans that do not include comprehensive maternity coverage. With almost half of pregnancies in the U.S. unplanned, a woman may not realize her plan does not include maternity care until it’s too late.

Young Invincibles is calling on Secretary Burwell to act quickly to create an SEP for pregnancy. And you can get involved, too! Sign our petition to ensure all pregnant women can get the care they need.

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