37% of People Switched Health Insurance Plans During Perinatal Period

More than a third of individuals with continuous coverage switched health insurance plans during the 12 months before or after giving birth, a study published in JAMA Network Open found.

Switching health insurance plans during the perinatal period can impact access to care, as health plans offer different benefits and provider networks.

Researchers gathered data from the Massachusetts All-Payer Claims Database (APCD) to determine the frequency and types of health insurance transitions that occurred during the perinatal period between January 1, 2014, and December 31, 2018. The Massachusetts APCD collects data for those enrolled in Medicaid, Medicaid managed care plans, and private insurers across the state.

The study sample included 97,335 deliveries from people between 18 and 44 years old who had continuous insurance during the 12 months before and after they gave birth.

Almost 24 percent of the deliveries were covered by Medicaid, 28.1 percent were covered by Medicaid managed care, 44.3 percent were covered by private insurance, and 3.1 percent were covered by a marketplace plan.

More than one in three individuals (37.1 percent) experienced an insurance transition during the year before or after delivery. Almost a quarter of those (24 percent) had only postpartum insurance transitions, 38.8 percent had only pre-delivery changes, and 37.2 percent had postpartum and pre-delivery transitions.

Individuals who had private insurance during their delivery month were less likely to experience an insurance transition compared to those with other insurance types, the study noted.

People with Medicaid were 47 percentage points more likely to have an insurance transition compared to those with private insurance. Similarly, the likelihood of having an insurance transition was 50.1 percentage points higher for people with Medicaid managed care.

Individuals with marketplace plans were also more likely to have an insurance transition during the perinatal period, with a 54.6 percent probability.

Adults between 18 and 24 years were 3.5 percentage points more likely to switch health plans compared to those between 35 and 44. In addition, people in zip codes with the lowest-quartile median income and concentrated poverty were less likely to have an insurance transition.

At six months postpartum, around 96 percent of individuals with private insurance in the delivery month remained enrolled in a private insurance plan. Among Medicaid beneficiaries, 80.1 percent maintained Medicaid coverage and 78.7 percent remained enrolled in Medicaid managed care.

Almost 65 percent of those who transitioned from Medicaid switched to Medicaid managed care, while 69.4 percent switched from Medicaid managed care to Medicaid.

Among those with marketplace coverage, 7.4 percent transitioned to a private health plan, 6.2 percent switched to Medicaid or Medicaid managed care, and 5.5 percent switched to the Health Safety Net. In contrast, at 12 months postpartum, 13.5 percent of people with marketplace coverage had switched to private insurance.

Insurance transitions increased over the postpartum year, researchers found. For example, 5.4 percent of people had a different insurance type two months after delivery, 13.4 percent had different insurance six months postpartum, and 18.5 percent had a different insurance type at 12 months postpartum.

Conducting further research could help determine what causes these insurance transitions and how they impact care access and maternal health outcomes, the study said.

Switching between Medicaid and Medicaid managed care was the most common type of transition. Medicaid plays a key role in covering maternal health services, including prenatal and postpartum care.

Federal law requires Medicaid to provide coverage for pregnancy-related care for at least 60 days postpartum. However, more than half of all states have now expanded Medicaid coverage up to a full year after pregnancy.