Timing of Conception Predicts Length of Marketplace Coverage During Pregnancy

Abstract Introduction We examined the timing of Marketplace coverage among women who gave birth while covered by a Marketplace plan in Massachusetts from 2020-2023. Methods We assessed whether Marketplace coverage began before or during pregnancy and examined gestational age at coverage start by date of estimated first positive pregnancy test (FPPT) and enrollment pathway (i.e., Open Enrollment Period [OEP] or Special Enrollment Period [SEP]). Results Just over half (52%) of the study population enrolled in the Marketplace during pregnancy, with most (72%) enrolling during the OEP. Coverage began, on average, five months into pregnancy and 15% started coverage within one month of delivery. Women with a FPPT during the annual OEP started Marketplace coverage significantly earlier in their pregnancy than women with a FPPT outside the OEP (14.3 vs 25.9 weeks gestation). Most (71%) women with a FPPT that fell outside of the OEP did not enroll until the next annual OEP. Conclusion Timing of conception relative to the annual OEP strongly predicted the length of Marketplace coverage during pregnancy. Most women who learned they were pregnant outside the OEP did not enroll until the next annual OEP, despite the availability of special enrollment options during the COVID-19 public health emergency.