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Women typically have seven to twelve prenatal visits over the course of a normal pregnancy. If any complications arise, they may have even more.
The amount your obstetrician charges for each visit could range from about $90 to more than $500. Additional services such as pregnancy ultrasounds and laboratory tests are typically billed separately, and usually cost upwards of $100 each. And special tests like amniocentesis can cost more than $2,500.
Depending on whether you have health insurance or not, and whether the prenatal care is considered routine or diagnostic, your actual out-of-pocket cost will be different. Exactly what counts as routine prenatal care is still being sorted out by the powers-that-be, and there are some costs that pregnant women are still paying out of pocket. For example, any visit that goes beyond the routine and becomes diagnostic can be subject to cost-sharing under the terms of your insurance plan. Also, your insurer may expect you to chip in for some care that might seem routine, like bloodwork or obstetric ultrasounds or not-routine-for-everyone prenatal testing. Those who don’t have health insurance must pay the entire cost of their prenatal care, but there’s some good news for those who do have insurance. The Affordable Care Act requires all qualified health insurance plans to cover routine prenatal care with no cost-sharing. That means no co-pays or co-insurance, and the visits are fully covered even if you have a deductible you haven’t yet paid.
How Health Insurance Covers the Cost of Your Prenatal Visits
If you have health insurance, preconception counseling is one of the services covered with no cost-sharing under the Affordable Care Act. It’s smart to visit your doctor or gynecologist even before you conceive to get a basic check-up and ask any questions you might have about your pregnancy plans. This is a good time to talk to your doctor about the best prenatal vitamins for you, especially folic acid supplements, which are recommended for all women who might become pregnant, because they can help prevent terrible birth defects like spina bifida and anencephaly. If you have insurance, make sure you get a prescription for your prenatal vitamins from your doctor, because your insurer will cover certain ones in full. If you just pluck them off the shelf yourself (and they are available over the counter), you won’t be reimbursed.
Prenatal care encompasses a variety of services, tests, and exams that are priced differently depending on their categorization as routine or diagnostic.
The Cost of Routine Prenatal Visits vs. Diagnostic Visits
At your prenatal visits, your doctor will monitor your health and that of your baby. She’ll probably check your urine, your blood pressure, your weight and the fetal heart rate. As your pregnancy progresses, she’ll also measure your abdomen and feel for the baby’s position. If you have health insurance, all of this routine prenatal care should be covered by your health insurance plan, with no charge to you.
If the obstetrician detects anything worrisome during her exam, or if you bring up a complaint that requires additional investigation, like unusual pain or bleeding, the billing code for your visit may change from routine to diagnostic, because now the doctor needs to figure out the problem. She may have to order some extra tests. This diagnostic prenatal care is generally not required to be covered by insurance with no cost-sharing. You may be responsible for copays, coinsurance, or payments toward your deductible, depending on the structure of your health insurance plan.
The Cost of Routine Screening Tests during Pregnancy
The healthcare law requires certain specific screening tests for pregnant women to be covered by insurance plans with no cost-sharing. These will generally be done as part of your regularly scheduled prenatal visits, often through blood work or urine tests. The free routine screening tests covered by your health insurance plan should include but are not limited to:
- Anemia screening
- Bacteriuria urinary tract or other infection screening
- Rh Incompatibility screening, and follow-up testing for women at higher risk
- Hepatitis B screening, at your first prenatal visit
- Gestational diabetes screening, when you’re 24 to 28 weeks pregnant, or at other times, if you are at high risk of developing this condition
- Syphilis screening
You can also get—fully covered—the screenings and services which are available to all women, such as tests for HPV, cervical cancer, HIV, Gonorrhea and Chlamydia; and counseling for things like domestic violence and tobacco use.
Screening tests that aren’t mandated by the Affordable Care Act may lead to out-of-pocket payments from you, based on your insurance plan cost-sharing structure.
If you have a perfect pregnancy with no complaints or complications, you might end up with free prenatal care, as long as you also have a generous insurance plan and you stay within your network. Everyone else will probably have some out-of-pocket costs, like co-pays or co-insurance for bloodwork or ultrasounds, or even paying the full costs of various tests up to your deductible. In addition, most new parents can expect a big bill for the cost of labor and delivery, as we will explore in a forthcoming guide.
Prenatal Care Without Health Insurance
If you’re pregnant with no health insurance, now would be a really good time to see if you can get it. Pregnancy is a common event, but it’s also incredibly expensive. The average cost of a having a baby, including prenatal care, delivery, and the first three months of newborn medical care, with a vaginal birth in 2010 was about $30,000, according to a 2013 Truven Health Analytics Marketscan Study. For cesareans (a.k.a. a C section), it was about $50,000.
For those who don’t have access to health insurance through an employer, or through your parents because you are under 26, consider buying an individual policy on your state’s marketplace or the federal exchange. You can only sign up for coverage during the open enrollment period, unless you have a qualifying event, like losing your insurance or moving to a new state or getting married. For coverage beginning January 1, 2016, open enrollment at healthcare.gov is between November 1, 2015 and January 31, 2016.
Beware: getting pregnant is not a qualifying event for health insurance! Dozens of consumer groups and federal legislators have been advocating to add a special enrollment period for pregnant women, to ensure their access to prenatal care. However, opponents worry this would create an incentive for women to forego insurance until they need it for their pregnancy costs.
One option for many unexpectedly expecting mothers is Medicaid or a state-sponsored program. Many states loosen their income requirements to offer free health insurance for pregnant women. In New York, for example, a pregnant single woman with no other children can get Medicaid even if she earns up to $35,524 per year. If she were not pregnant, she would have to earn $16,243 or less to qualify for Medicaid. In New Orleans, a pregnant woman qualifies for free health care if she earns less than $16,248 per year. (Income limits are higher for larger families.) Non-pregnant women generally can’t qualify at all.
Even if you don’t have health insurance, you should get prenatal care for the good of yourself and your baby. Children born to mothers who don’t get prenatal care are five times more likely to die compared to infants born to mothers who did go to the doctor regularly while pregnant. And moms themselves are three to four times more likely to die without this important medical attention.