I’m Covered Stories: And Baby Makes Three with a Special Enrollment

Posted July 1, 2014
By Judy Sarasohn, Public Affairs, Department of Health and Human Services

Stephanie and Justin Parker of Wilmington, N.C., had gone without health insurance for several years because they couldn’t afford it. When the Health Insurance Marketplace opened, they figured they would check out their options in early 2014.

They pushed up their plans when a couple of days after Christmas, Stephanie learned she was pregnant. They found an affordable gold plan through the Marketplace that after assistance costs them $260 a month, much less than the $700 they had been quoted for a non-Marketplace plan. With her new plan, her eight doctor visits and six ultrasounds so far have cost them only $15 out of pocket, Stephanie told me.

A growing family will be covered. Stephanie and Justin, +1 due in September. Special Enrollment: Baby or Adoption. HealthCare.gov.But what about health coverage for the baby? They’re not worried: Even though open enrollment doesn’t begin again until November with coverage beginning in January, Stephanie, 27, and Justin, 28, will be able to get their baby on their plan when she arrives in September.

Under the Affordable Care Act, folks with special circumstances, such as the birth or adoption of a child, a recent marriage, or aging off a parent’s insurance plan at 26, may qualify for a special enrollment period and be able to enroll in a Marketplace plan in advance of November’s open enrollment. Additionally, if you or your children are eligible for Medicaid or CHIP, you can enroll at any time.

So after the birth of their baby in September, the Parkers plan to adjust their insurance to cover all three of them.

They know how important it is not to delay because they learned the hard way how expensive unexpected care can be. Their Marketplace plan didn’t go into effect until February 1, but Stephanie started to show signs of possible complications before then and needed to see a doctor.

“I was trying hard to wait but I couldn’t.” she said. She went to the ER on January 27, four days before her insurance went into effect. Fortunately, her pregnancy was not in danger, but the bill for an ultrasound and consultation with a doctor came to about $2,100.

It’s ironic, Stephanie noted, that they are insurance agents themselves who could not afford coverage without the Affordable Care Act. She works for a small company that does not offer health insurance benefits, and Justin is self-employed.

Stephanie said that without the law, she probably would have been turned down for insurance because of her pregnancy, a pre-existing condition that now can’t be held against her.

After the baby arrives, Stephanie said she’s going to use the preventive services, like a well-baby visit, that the Affordable Care Act requires insurers to cover at no out-of-pocket charge.

Said Stephanie: “She’ll have very good coverage!”

Content last reviewed on July 1, 2014