{
  "abstract": "We examined the timing of Marketplace coverage among women who gave birth while covered by a Marketplace plan in Massachusetts from 2020 to 2023. 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 (ie, open enrollment period [OEP] or special enrollment period [SEP]). 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, 5 months into pregnancy and 15% started coverage within 1 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. 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.",
    "Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA.",
    "Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA 02118, USA.",
    "Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118, USA.",
    "Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.",
    "Department of Obstetrics and Gynecology, University of South Florida Health Morsani College of Medicine, Tampa, FL 33606, USA."
  ],
  "article_type": "brief report",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Olesya Baker",
      "orcid": "0000-0001-9125-2761"
    },
    {
      "affs": [
        0
      ],
      "name": "Matt Lakoma",
      "orcid": "0009-0001-2135-3927"
    },
    {
      "affs": [
        0
      ],
      "name": "Stephanie Argetsinger",
      "orcid": "0009-0009-6249-2358"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Sengwee Toh",
      "orcid": "0000-0002-5160-0810"
    },
    {
      "affs": [
        2
      ],
      "name": "Alison A Galbraith",
      "orcid": "0000-0002-7309-5915"
    },
    {
      "affs": [
        3
      ],
      "name": "Sarah Gordon",
      "orcid": "0000-0003-4743-2014"
    },
    {
      "affs": [
        4
      ],
      "name": "Anna D Sinaiko"
    },
    {
      "affs": [
        5
      ],
      "name": "Anjali Kaimal",
      "orcid": "0000-0002-7015-6583"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Laura F Garabedian",
      "orcid": "0000-0002-0014-4181"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2z4frmka2g57z.bib",
  "cited_by": 0,
  "doi": "10.1093/haschl/qxag270",
  "fulltext_url": "https://europepmc.org/articles/PMC13714903",
  "id": "2z4frmka2g57z",
  "issns": [
    "2976-5390"
  ],
  "landing_url": "https://europepmc.org/article/MED/42953209",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00862"
    ],
    [
      "heading",
      "AcademicSubjects/SOC02360"
    ],
    [
      "heading",
      "Brief Report"
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      "heading",
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      "heading",
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      "openalex",
      "2002|Healthcare Policy and Management"
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  "openalex": "W7221104643",
  "pdf_url": "https://europepmc.org/articles/PMC13714903?pdf=render",
  "pmcid": "PMC13714903",
  "pmid": "42953209",
  "published": "2026-10-09",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/2z4frmka2g57z.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:41Z",
      "native_id": "MED:42953209",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42953209"
    },
    {
      "first_seen": "2026-11-01T12:22:18Z",
      "native_id": "PMC13714903",
      "source": "pmc",
      "url": "https://doi.org/10.1093/haschl/qxag270"
    }
  ],
  "subjects": [],
  "title": "Timing of conception predicts length of marketplace coverage during pregnancy.",
  "title_text": "Timing of conception predicts length of marketplace coverage during pregnancy.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:22:18Z",
  "url": "https://research.draconitic.com/paper/2z4frmka2g57z",
  "venue": "Health affairs scholar",
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}