Is pregnancy considered a pre-existing condition?

A pre-existing condition is any potentially serious health condition that can make it more difficult to locate affordable insurance. Pre-existing conditions often include illnesses such as heart disease, asthma, and diabetes. In order to limit losses, insurance companies could exclude coverage for certain serious health conditions and limit coverage for others. Laws govern how insurance companies treat those with pre-existing conditions.

For example, according to the Health Portability and Accountability Act of 1996, pregnancy is not subject to a pre-existing condition. That means that if you purchase your insurance through your employer, even if you had no credible health coverage prior to enrollment, you cannot be denied coverage. However, some individual health insurance plans can and do consider pregnancy to be a pre-existing condition, and they can limit or deny coverage based on a woman’s pregnancy status.

An estimated 13 percent of American women who become pregnant every year do so without the protective cushion of personal health insurance. Women without insurance may be less likely to seek regular prenatal care, which can lead to a higher risk of complications, preterm birth, and even neonatal death. Insurance is a valuable resource that can help keep both mothers and babies safe and healthy throughout pregnancy and beyond.

Maternity care may be offered as a rider to traditional personal health insurance plans, but these often have waiting periods and can be exorbitantly expensive. Medicaid is another alternative. It is a federal health insurance program for low-income individuals. Women who are pregnant may be eligible to receive Medicaid benefits that can help them pay for the regular health care they need, as well as any necessary tests and medications to ensure they have the healthiest possible pregnancy.

The Patient Protection and Affordable Care Act will also provide broader coverage for many, including pregnant women and those with pre-existing conditions. As of 2014, all insurers will be required to cover maternity care and other essential coverage for those with pre-existing conditions, including pregnancy.

To learn more about pre-existing conditions, visit HealthCare.gov.

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