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Peer-reviewedCC BY-NCHealth affairs scholar

Timing of conception predicts length of marketplace coverage during pregnancy.

  • Olesya Baker1
  • Matt Lakoma1
  • Stephanie Argetsinger1
  • Sengwee Toh1,2
  • Alison A Galbraith3
  • Sarah Gordon4
  • Anna D Sinaiko5
  • Anjali Kaimal6
  • Laura F Garabedian1,2
6 affiliations
  1. 1Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.
  2. 2Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA.
  3. 3Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
  4. 4Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118, USA.
  5. 5Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
  6. 6Department of Obstetrics and Gynecology, University of South Florida Health Morsani College of Medicine, Tampa, FL 33606, USA.
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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.

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Cite

BibTeXRIS
BibTeX
@article{baker2026timing,
  title = {{Timing of conception predicts length of marketplace coverage during pregnancy.}},
  author = {Olesya Baker and Matt Lakoma and Stephanie Argetsinger and Sengwee Toh and Alison A Galbraith and Sarah Gordon and Anna D Sinaiko and Anjali Kaimal and Laura F Garabedian},
  journal = {Health affairs scholar},
  year = {2026},
  month = oct,
  doi = {10.1093/haschl/qxag270},
  url = {https://europepmc.org/article/MED/42953209},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Timing of conception predicts length of marketplace coverage during pregnancy.
AU  - Olesya Baker
AU  - Matt Lakoma
AU  - Stephanie Argetsinger
AU  - Sengwee Toh
AU  - Alison A Galbraith
AU  - Sarah Gordon
AU  - Anna D Sinaiko
AU  - Anjali Kaimal
AU  - Laura F Garabedian
PY  - 2026
DA  - 2026/10/09
JO  - Health affairs scholar
DO  - 10.1093/haschl/qxag270
UR  - https://europepmc.org/article/MED/42953209
AB  - 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.
SN  - 2976-5390
ER  -