Navigating the world of health insurance isn’t easy – or fun. And it’s common to feel overwhelmed or avoid making decisions when it comes to signing up for or changing health insurance. But it’s important that you understand how to get the best health insurance for your particular situation so you don’t get a surprise bill that could negatively impact your finances.
If you’re pregnant or planning to become pregnant, it’s even more critical that you have a clear picture of how your prenatal care, baby’s birth and the new addition to your family might impact your coverage and premiums.
Rest assured, these situations are not uncommon, and there’s flexibility in your health insurance choices.
Continue reading to delve into the frequently asked questions of when and how to change your health insurance plan.
Can I change health insurance at any time?
Most employers that offer group health insurance have an annual Open Enrollment Period, which is usually in the fall. During this time, you get the opportunity to reassess and modify your existing health insurance plan to ensure it aligns with your family’s evolving needs.
In most cases, health insurance changes are only allowed during these annual enrollment periods. But if life brings about significant changes throughout the year, you can promptly update your plan during a Special Enrollment Period.
You qualify for a Special Enrollment Period if you’ve had certain life events, including the following:
- losing health coverage
- moving out of range of in-network providers
- getting married or divorced
- your spouse passes away
- having a baby or adopting a child
- you turn 26 and no longer have access to your parent’s health insurance
- if your household income is below a certain amount
- you no longer qualify for Medicaid, Medicare, or Children’s Health Insurance Program (CHIP)
- you become a citizen of the US
Can I switch health insurance while pregnant?
You can switch your health insurance while pregnant only during the Open Enrollment Period or if you have experienced one of the other life events listed above.
Pregnancy does not qualify you for a Special Enrollment Period, but giving birth does. After you have a baby, you can switch insurance because the number of dependents you have has changed, allowing you to switch outside of the typical Open Enrollment Period.
If you do experience a qualifying life event while you’re pregnant and qualify for a Special Enrollment Period, make sure to let your insurance know as soon as the event happens, as you typically will have up to 30 days to enroll in your new plan.
You may be asked for documentation related to your qualifying life event, so make sure you have your paperwork in order to avoid delays.
The great news is that all government marketplace and Medicaid plans cover pregnancy and childbirth. This is true even if your pregnancy begins before your coverage starts.
Maternity care and newborn care are considered “essential health benefits.” This means all qualified health plans inside and outside the Marketplace must cover them.
If you’re pregnant without insurance, read up on your options or call Healthcare.gov help line to learn more.
Call 1-800-318-2596 (TTY: 1-855-889-4325).
What are the reasons for switching insurers?
Common reasons for switching insurers include the following:
- changes in life circumstances
- a significant increase in insurance costs for your existing plan
- dissatisfaction with current coverage
- or the availability of better coverage options or different in-network providers or hospitals.
When is the Open Enrollment Period?
The Open Enrollment Period typically occurs once a year, usually in the fall. Exact dates may vary by employer or insurance plan, so it’s crucial to stay informed about the specific Open Enrollment Period for the current year. Check the HealthCare.gov website for exact dates and deadlines.
How do I get health insurance?
Enrolling in new health insurance can be done through various channels, including online marketplaces such as healthcare.gov, your employer (if they offer health insurance), insurance brokers and agents, or directly through the insurance provider.
What do I do after I switch health insurance?
After switching health insurance, take a close look at your new plan’s benefits, coverage details, and any changes in providers.
Most insurance companies have a “Find a Doctor” search on their websites, and many will mail you printed materials to view your options. If you are unable to find your doctor using this approach, you can also call the health plan and ask if the doctor is in network. If you call, you will have the best luck if you use the provider’s National Provider Identifier, or NPI number. This is like a Social Security Number for medical providers. If your doctor and regular providers are no longer “in network,” you’ll want to choose a new primary care provider and set up any annual or regular appointments you may need.
Note: It’s a good idea before you switch to check out the provider options in case you want to keep your same doctor or if you have a specific hospital you want to use. Keep in mind that Madison Women’s Health does its obstetric deliveries and surgeries out of UnityPoint Health-Meriter Hospital. In rare cases, some health plans will cover you to see a Madison Women’s Health provider, but not necessarily services at Meriter Hospital; so please call Meriter Hospital (608-417-6000) to check on this.
After switching insurance, don’t forget to:
- Contact Madison Women’s Health or other providers right away so we can update your records, especially if you’re pregnant.
- Cancel your other health insurance (if you have individual coverage) and remove any automatic billing that might be associated with your bank account so you don’t get double billed.
- Set up automatic payments to your new insurance if applicable so you don’t have to have to mail in checks every month.
- Put your new insurance card in your wallet and present it at your next doctor visits.
It’s essential to update your healthcare information with providers and pharmacies and familiarize yourself with any new policy requirements before you get care.
How do I cancel my health insurance?
To cancel health insurance that is your own (not through an employer), contact your insurance agent, old insurance provider, or the marketplace through which you obtained coverage. Be sure to follow the cancellation procedures outlined by both the new and old insurer to avoid any gaps in coverage or double billing.
How can I get help with getting health insurance?
For assistance with obtaining health insurance, explore resources such as healthcare.gov (the government health insurance marketplace), local health insurance agents, or community health centers.
What insurance does Madison Women’s Health take?
Madison Women’s Health accepts a variety of insurance plans to ensure comprehensive and accessible healthcare for our patients.
While we may be participating with health plans, we always encourage you to check with your insurance company to confirm that we are an in-network provider for your specific benefit plan.
We are participating providers for the following health plans:
- The Alliance
- Anthem Blue Cross/Blue Shield
- BadgerCare (Wisconsin Medicaid)
- First Health Network (Coventry Health Network)
- HealthEOS (includes Aetna)
- Humana (limited options)
- Quartz Plans
- Chorus Community Health Plan (formerly WEA Health Insurance)
- WPS Health Solutions
Other Insurance Plans
We also accept other non-network plans and fee-for-service insurance, such as “Choice” plans or “Point of Service (POS)”, as well as self-pay arrangements. Patients under these plans may pay more out-of-pocket to see our providers.
For more information about your Medicare benefits, please visit our Medicare Services page.
If you have any questions about our providers and whether they are covered under your specific insurance benefit plan, we encourage you to contact your insurance company. It may be helpful to use our clinic’s National Provider Identifier (NPI) number, which is 1174851851. Individual provider NPI numbers can be given out upon request.
Above all, we hope this article will help you understand the ins and outs of switching health insurance.