What You Need to Know
Pregnancy and childbirth can cost thousands of dollars.
If you have major medical insurance, chances are your policy will cover most out-of-pocket costs related to pregnancy and childbirth after you meet your deductible.
In many cases,options for health insurance exist at all stages of the pregnancy. Even if you don’t have insurance, you have options.
You’re having a baby? Congratulations!
Lots to prepare. But don’t forget one thing: how you’ll pay for it. The cost of giving birth runs into the thousands, even the tens of thousands.
How Much Does It Cost to Have a Baby?
The first thing to know about having a baby: what’s the cost?
Well, let’s put the numbers into two buckets:
- Care you receive up to birth (prenatal)
- Care you receive when you deliver the child
Some studies put the total cost anywhere from $30,000 to $50,000. But that doesn’t mean you’ll pay that much. Where you live and your insurance, if you have it, matter more.
Prenatal Care Costs
When you or your partner find out you’re pregnant, you’ll likely go to a doctor to confirm.
How much you pay will depend if you have insurance and the kind of coverage.
Affordable Care Act
Health plans that meet the standards of the Affordable Care Act (ACA) will cover out-of-pocket expenses after the deductible is met. You might have to pay for coinsurance once the deductible is satisfied, depending on your coverage. The law required insurers to cover a some maternity-related screenings free of charge.
Major medical plans you buy off healthcare.gov will comply with this. So will major medical plans you may get through an insurer.
So, your expected cost would be any copayments, the medical deductible and coinsurance. Those numbers can range from hundreds or even thousands of dollars. Of course, this all depends on your policy.
Also, if you apply for an ACA plan, you could qualify for two kinds of subsidies to pay insurance costs:
- Advance Premium Tax Credits:
- Cost-Sharing Reductions
The tax credits will reduce how much you pay each month (premiums) for your coverage.
The cost-sharing reductions will reduce any copay or deductible you may owe when you go to the doctor.
Medicaid will cover prenatal care at little or no cost to you. Simple! You just have to qualify and enroll for the coverage. Eligibility and requirements vary by state.
No insurance? Well, you will be required topay the cash price for exams and tests. Those can run into thousands of dollars.
But doctors and hospitals may also work with you on the final price. You could negotiate the amount down if you pay the total in one shot. Or you could arrange to pay the bill over time.
You also have options to apply for coverage.
You can apply on the federal health insurance marketplace for individual or family plans. But you’ll need a reason to qualify for a Special Enrollment Period (SEP).
Typically, insurance carriers restrict when you can enroll. To enroll outside of that period, you need to qualify for a SEP.
Situations like moving or losing your health insurance qualify you for a Special Enrollment Period.
What you pay when you give birth depends on your insurance, if you have it, where you live, and your medical provider’s pricing.
If you have insurance, you’ll expect to pay anywhere from $3,000 to $5,000 out of pocket, according to a 2020 Health Affairs study.
|Delivery Method||2008 Cost||2015 Cost|
The Cash Price of Pregnancy
Turquoise Health gathered the cost of procedures from hospitals across the country.
Vaginal deliveries averaged about $8,500 while cesareans cost around $15,000.
Vaginal Delivery Price
|Location||Cash Price Range|
|New York City||$3,300 – $50,000|
|Los Angeles||$5,200 – $19,200|
|Dallas||$4,000 – $23,300|
Cesarean Delivery Price
|Location||Cash Price Range|
|New York City||$3,300 – $63,000|
|Los Angeles||$7,300 – $158,000|
|Dallas||$5,900 – $27,700|
If you give birth and you don’t have insurance, you have several options.
Giving birth lets you buy an insurance plan outside the normal Open Enrollment Period. (Note that expenses incurred while pregnant and during delivery will not be covered. This insurance would be for you and your new baby going forward.)
A 60-day Special Enrollment Period lets you and your baby sign up for coverage.
So, you would end up being responsible only for the cost-sharing of coverage in the future, which would be any copays, deductible and coinsurance.
If you buy a benchmark silver plan, for example, your copay could run $50 a visit to a specialist and your deductible start at $2,000.
If you qualify for Medicaid based on your household income, your care is either low-cost or free. You could qualify for Medicaid coverage for 60 days after you give birth.
If you apply for coverage after that time, you may not be able to sign up.
And if you enrolled in Medicaid, your newborn baby would join you and get coverage too.
How Do You Save on Costs?
You can make things easier by taking a few steps to limit and minimize your bill for delivery and doctor visits.
Do your homework
Make sure your doctors and hospitals are all in-network. Insurance carriers negotiate directly with providers on price. That also means you pay less when you go to those doctors and hospitals for services.
Not sure of your coverage?
Call your insurance company and find out what is and is NOT covered. Chances are your carrier will cover most services related to prenatal care and childbirth.
Know Your Numbers
Familiar yourself with the out-of-pocket expenses you expect to pay. You’ll have enough going on once your child has arrived.
Nine months will go by quickly. It’ll be a whirlwind, and soon that bun in the oven will be a bundle of joy in your arms.
Plan ahead and early. Know your options. If you do, you’ll be on a sound footing that welcoming your little one won’t create other financial problems at home.