When you’re pregnant, you may spend a lot of money on baby gear, and some on prenatal care, but your biggest bills will likely arrive shortly after the baby does—for labor, delivery, and the medical care you and your newborn get when you give birth. Here we'll cover the average cost of pregnancies - from both sticker price to allowable amounts under health insurance plans, show what types of services are included in the costs, and explain how health insurance plans cover deliveries.
- Cost of Childbirth
- How Health Insurance Covers Childbirth
- How Much You'll Pay to Have a Baby - with Health Insurance
- Delivering without Health Insurance
The sticker price for a vaginal birth in 2010 ranged from an average of $12,599 for women with Medicaid to about $16,165 for women with private (including employer-provided) insurance, according to a 2013 report by Truven Health Analytics Marketscan. The average cost of a C-section was about $20,680 for women with Medicaid, and $24,572 for those with other insurance. About one-third of U.S. births are cesarean sections. Both Medicaid and private insurers negotiate discounts with providers, so the actual allowed amount for vaginal childbirth in 2010 was $3,347 to $9,048, and $4,655 to $12,739 for a C-section.
This changes if you're considering alternative delivery methods. Some pregnant women are opting for an approach to childbirth that’s different from the common medical version: less clinical and, hopefully, less expensive. You could use a midwife for maternity care, deliver at a birthing center, or even have your baby at home. Costs will generally be lower in these settings, but you won’t have access to as much high-tech medical care if something goes wrong. Women report their share of the costs at a birthing center or for a home birth with a midwife to be in the ballpark of $3,000. Insurance plans vary widely in how they cover midwives and birthing centers.
Cost of Birth in Hospital
Nearly 99 percent of births in the U.S. take place in hospitals, making childbirth the most common reason for hospitalization. If you give birth in a hospital, you’ll spend at least one night there, more if you’ve had a cesarean section (a C-section). And you’ll typically need the services of nurses, anesthesiologists and an obstetrician or midwife. You may have procedures like fetal monitoring and postnatal care for you and your newborn. The costs for all these elements of a hospital birth add up. Here is a breakdown of how the cost of a routine delivery in a hospital may look, as per Healthcare.gov:
|Routine Hospital Delivery Charges||Cost|
|Mother’s hospital charges||$2,700|
|Routine obstetric care||2,100|
|Baby hospital charges||900|
|Vaccines, other preventive||40|
Health insurers must cover maternity care and childbirth. This is one of the ten essential health benefits required by the Affordable Care Act. Only grandfathered individual plans are exempt from this requirement. All other plans, including those on any state exchange or on the federal marketplace; those offered by employers; and those offered for the first time after 2013, must cover these ten essential benefits.
Health insurance plans can, and most do, require pregnant women to shoulder a portion of their costs for labor and delivery. But the Affordable Care Act makes it a bit easier to understand exactly how this may work, because it requires insurers to create a standardized Summary of Benefits & Coverage document (SBC) for each plan they offer. One coverage example standardized across each plan's SBC is having a baby with a normal delivery.
One unpleasant financial surprise for many new parents: your newborn may start running up her own medical bills from the moment she is born. Insurance plans for families can charge a deductible and out-of-pocket costs for each covered individual, including your new little bundle of dollar signs, up to a predetermined maximum.
Also, insurance plans vary widely in how they cover midwives and birthing centers, and specifically which ones are in-network providers, so consult your insurer before you make this choice for your maternity care. If you have to pay all the costs out of pocket yourself, you could end up spending more than if you just paid the cost-sharing requirements of your health insurance plan.
The amount you will pay out of pocket for the costs of childbirth will depend largely on whether or not you have health insurance, and if you do, on the cost-sharing structure (deductibles, copays and coinsurance) of the plan you choose. If you do have health insurance, you may have to pay your deductible towards your inpatient care when you deliver your baby. You could also have copays or coinsurance towards things like medications, physician services or radiology.
Let’s use an example to illustrate total out of pocket costs for a mom-to-be with health insurance coverage. A 32-year-old woman and man in Wayne County, Michigan, got married and planned to have a baby in 2015. Their marriage was a qualifying life event for enrolling in an insurance plan on MI's health insurance exchange, so they started looking at their options. She called her obstetrician and the hospital where she planned to deliver and learned they were both in-network with the UnitedHealthcare plans on the exchange, so they only considered those.
Sample Patient Costs with Deductibles and Coinsurance
The chart below shows various scenarios assuming different United HealthCare plan options for the couple. We've assumed they live in Livonia (zip 48150), and for simplicity, have only shown healthcare costs just for the expectant mother. Patient costs assume deductibles, copays, coinsurance as well as any limits or exclusions for the mother:
|Example Patient's Plan||Annual Premiums||Deductible||Patient Costs||Est. Outlay|
|Bronze Compass HSA 4900||$4,346||$9,800||$5,120||$9,466|
|Bronze Compass 5500||4,795||5,500||5,920||10,715|
|Silver Compass HSA 2600||5,101||5,200||2,810||7,911|
|Silver Compass 2000||5,244||2,000||3,520||8,764|
|Silver Compass 3500||5,295||3,500||4,310||9,605|
|Silver Compass 5000||5,300||5,000||5,510||10,810|
|Silver Compass HSA 1600||5,315||3,200||3,300||8,615|
|Gold Compass 500||5,693||500||1,900||7,593|
|Gold Compass 1250||5,800||1,250||2,010||7,810|
|Platinum Compass 250||6,366||250||1,100||7,466|
As you can see, since this couple is anticipating the major health costs of pregnancy and delivery, they are best off with the platinum plan in this scenario. Though it has slightly higher monthly premiums, it offers much more coverage for their expected costs.
What about in a bad-case scenario, where the woman has a complicated delivery, or her husband has health costs too? Based on our research, the platinum plan still presented the best option because of the lower out-of-pocket maximums, which capped the most the couple had to pay on their own. In this case the platinum plan could save them up to $10,000, compared to some of the other available plans offered by UnitedHealthcare.
Questions to Ask Your Health Insurance Provider
Find out how your health insurance handles these particulars. Call the number on the back of your card and ask things like:
Question: Can one family member’s health care costs add up to the total family deductible or out-of-pocket max? Or are they capped at an individual level?
This is significant because the cost of labor and delivery for a new mother are so high. For most family plans, it’s the former, meaning problems with your delivery or with the baby (or with another family member’s health) could quickly bring your bills up to the family’s out-of-pocket maximum in a given year, which can be as high as $13,200 for in-network care, as of 2015. However, some plans cap any individual family member’s possible deductible and out-of-pocket max at lower levels. So if you only have one person in your family with healthcare costs, and everyone else is healthy, ultimately your family’s out-of-pocket payments could be much lower. You can also check your plan’s Summary of Benefits and Coverage, which should indicate whether individual limits apply if your plan covers two or more people.
Question: Once I add my new baby to my plan, when will s/he start to incur charges towards his or her deductible, copays and coinsurance?
According to reports from women who’ve recently had a baby, some plans cover the newborn’s hospital care under the mother’s cost-sharing requirements, until both are released from the hospital. Others consider the baby a new individual family member from the date of his birth, when his bills accrue to his own deductible and cost-sharing. These might include his hospital stay, physician visits and lab tests ordered.
Also, note that if you don’t already have a family plan, the addition of your baby can push you into one, with an accompanying rise in monthly premiums.
How your health insurer handles these issues can make a difference of thousands of dollars to your family budget.
If you don’t have health insurance, you’ll be responsible all the costs for prenatal care and the birth of your child. However, many states make it easier for pregnant women to enroll in Medicaid or a state-sponsored health insurance program, through which all of your health care will be free or very low cost. In California, for example, a pregnant single woman with no other children can get Medicaid even if she earns up to $24,481 per year. If she were not pregnant, she would have to earn less than $15,654 to qualify.
Those who can’t get coverage through a public program or through an employer should be able to buy a plan through their state’s health insurance exchange or through healthcare.gov. Important caveat: unless you have another qualifying event like getting married or divorced or moving to another state, you can only sign up for one of these plans during the open enrollment period between November and January, even if you get pregnant at another time during the year.
If you don’t have health insurance, you may be able to negotiate prices with the doctor and hospital where you deliver your child. However, be aware that without insurance, your expenses for a complicated delivery or a seriously ill newborn could reach into the high tens, or even hundreds, of thousands of dollars.
It’s hard to get around the expenses of childbirth. But if you’re pregnant, or trying to conceive, take a hard look at your options for health insurance coverage. Consider both your premiums, and all the out-of-pocket costs you are likely to have to pay for your maternity care, from prenatal visits, to ultrasounds, to common prenatal tests, as well as the costs of labor and delivery. (Don’t forget your newborn’s share!)
When you’re facing a lot of expectable medical care, it may make financial sense to choose a plan with higher premiums, if you’ll save money on the back-end, with lower deductibles and out-of-pocket maximums.