Surrogacy & Health Insurance Through the Affordable Care Act
OK, so it’s still a little early, but it looks like we will have ACA health insurance options for next year (2020) in New England.
If that sounds like gibberish to you, let me explain a bit more. The Affordable Care Act is a federal law that set up a program where each state had to find a way to allow its residents to purchase individual health insurance plans (specifically, major medical plans).
There were several different ways that states could set their programs up. Massachusetts, Connecticut, Vermont, and Rhode Island established their own health insurance marketplaces. New Hampshire operates its plan through a state-federal partnership, and Maine’s plan is through the federally run marketplace (check out this nifty map to learn more). Whichever way the program is set up, the bottom line is that the state’s residents have several options to choose from for a major medical plan.
So what’s a major medical plan? This is what we typically think of as “health insurance”. It covers the 10 essential health benefits mandated by the Affordable Care Act (ACA)—this includes the essential health benefit of maternity care. Under the ACA, anyone can apply for major medical insurance, as long as you do so during open enrollment, and premiums are the same no matter what pre-existing conditions you have. Surrogates, like anyone else, can sign up for this kind of insurance during their state’s open enrollment period. That’s the good news.
The bad news is that some states don’t have any policies available that are appropriate for surrogacy. Meaning that none of the available health insurance plans will cover the surrogate’s maternity care for the pregnancy, delivery, and post-partum period. As an aside, how do you know if a plan is appropriate? The best way is to have it reviewed by ART Risk or a lawyer who specifically understands the nuances of surrogacy health insurance (luckily, our own Catherine Tucker is one who does, but we often work with ART Risk too).
Fortunately, we have had good health insurance options available in the past in all six New England states--New Hampshire, Maine, Vermont, Connecticut, Rhode Island & Massachusetts. We don’t yet know exactly what the plans for next year (2020) will look like but we are optimistic that we will have viable options. We are working with ART Risk to better understand the options for next year.
One important thing to keep in mind is that these health insurance plans are only accessible during open enrollment or upon the occurrence of a qualifying event. Open enrollment will run as follows this year in New England:
New Hampshire: November 1, 2019 to December 15, 2019
Vermont: November 1, 2019 to December 15, 2019
Maine: November 1, 2019 to December 15, 2019
Massachusetts: November 1, 2019 to January 23, 2020
Rhode Island: November 1, 2019 to December 15, 2019
Connecticut: November 1, 2019 to December 15, 2019
Yep, that December 15th date is correct even though it falls on a Sunday. Note that, in the past, Connecticut, Vermont, and Rhode Island have all extended their deadlines but there is no guarantee that they will do so again this year.
These open enrollment dates are for purchasing insurance coverage that starts on January 1, 2020. In order to qualify for January 1st coverage, you must purchase the insurance by December 15th. In Massachusetts, which has a longer open enrollment period, you can still purchase insurance for a few weeks longer, but the coverage will have a later start date.
If you miss open enrollment, you are out of luck unless you have a qualifying life event. A qualifying life event means one of a specific list of major life changes. Some examples can be: getting married, having a baby, getting divorced which causes a loss of health insurance, moving long-distance, and losing job-based health insurance.
An important thing to note is that getting pregnant is usually not a qualifying event. This means your surrogate generally cannot use the pregnancy as a way to qualify for health insurance outside of the open enrollment period. Good news if your surrogate lives in Vermont or Connecticut, though, because she may be able to use pregnancy as a qualifying event to obtain insurance outside of open enrollment (big shout out to Vermont & Connecticut for their great rules!!). Be prepared to provide proof of her pregnancy with medical records.
Also be prepared to be flexible if necessary. In particular, surrogates should be aware that networks are getting smaller and thus they may need to change OBs or delivery hospitals. Is this ideal? No. But it’s a reality in today’s insurance environment.
And lastly, subsidies. Generally your surrogate should not be using government subsidies to purchase health insurance because subsides are a form of need-based government assistance, which is an automatic disqualifier at many agencies. However, if your surrogate is not being compensated, it may be acceptable to use a subsidy—please discuss this with your lawyer.
So that’s the scoop on Affordable Care Act options in New England at this time. If an ACA plan is not the right fit for your match, there are a few other options to cover the surrogate’s medical bills. We’re happy to discuss your options in more detail with you.
One quick caveat: We are providing this information as a courtesy only. We cannot get into the level of detail here that would be required in order to figure out your particular options. Please contact ART Risk or another insurance broker to confirm open enrollment dates & other details as they apply to your situation.