Pregnancy is a time of excitement and anticipation. One thing you should definitely anticipate is how much your maternity and delivery will cost you out-of-pocket. But with some research ahead of time, you can get as financially prepared as you can for your new baby’s arrival, and perhaps save thousands.
So, how much does it cost to have a baby in 2020? The national average for pregnancy and newborn care is about $30,000 for a vaginal delivery without complications and $50,000 for a cesarean section (C-section), according to Truven Health Analytics. But your actual costs could vary wildly, up or down.
Your pregnancy costs depend on four factors.
1. Complexity of the Pregnancy and Delivery
The complexity of your pregnancy and delivery is hardly something you can control. While your plan may be to deliver vaginally, circumstances might make a C-section the safest option. A study by Truven found that cesarean births can cost as much as 50% more than vaginal birth.
It’s important to have a thorough understanding of what your health insurance plan will and won’t cover. The Pregnancy Discrimination Act of 1978 and the 2010 Affordable Care Act have made it very rare for plans to refuse to cover maternity and newborn care, aside from short-term plans. However, one fairly common wrinkle is dependent on maternity care, which applies to pregnant women covered under their parent’s insurance. If you are still on your parent’s plan, be sure to check whether the plan covers your maternity and delivery — at all.
2. Network Types
Consider the plan network options available to you when planning a family. Having a baby is considered a qualifying life event for you and your baby, which means you can get health insurance after delivering without having to wait for the late-year open enrollment period. It is easy to get health insurance for your baby once he or she is born. But note that this is after you have your baby; pregnancy is not a qualifying life event. So if you are thinking of having a child, be sure to enroll in an insurance plan during the nationwide open enrollment period in the fall. If you have insurance and think you might become pregnant soon, you need to do some homework to see whether you can save money by changing plans during your plan’s open enrollment period. Some network options include:
PPO (Preferred Provider Organizations) Plans typically have higher monthly premiums but lower deductibles. They also include copays for routine office visits, prescriptions, etc. These types of plans give you the greatest flexibility in choosing the doctor and hospital you want to deliver your baby, which is very important to a lot of moms-to-be.
HMO (Health Maintenance Organizations) Plans usually have lower costs and often cover most costs associated with pregnancy. However, your access to providers is more limited. For example, you have to stay within your HMO network, and you need to get a formal referral from your primary care physician — your gatekeeper — to see a specialist. . If financial savings are important at this point and you’re open to delivering in any nearby hospital with a doctor specified by your plan, an HMO may be the way to go.
HDHPs (High Deductible Health Plans) are just as the name suggests: plans with higher deductibles in exchange for lower monthly premiums. There are no copays, meaning the patient is charged the full amount for a doctor’s visit or prescription. These plans are often linked to a Health Savings Account, allowing you to save pre-tax dollars to pay for the higher cost of the doctor’s visits and prescriptions. High deductible plans are not often recommended for pregnancies because once you enter a hospital, you will most likely face bills forcing you to pay out of pocket your full high deductible. For many, that’s an unappealing expensive option at this stage of their lives as they expand their household.
3. Your Chosen Hospital and OB GYN
First, check to make sure the delivery doctor and hospital you want are in your plan’s provider network. Don’t assume that just because the hospital is in-network that the doctor is, too. Your Ob Gyn may have a contract to deliver at the hospital you like, but not have a contract with your insurance company. Physicians typically bill for services separately from the hospital. So if your doctor is not in your plan network you will get hit with all sorts of surprise bills that you’ll likely owe out of pocket.
Second, understand that costs vary widely from hospital to hospital and doctor to doctor, making it nearly impossible to anticipate what you will be charged. A University of California study found that women in the state could be charged anywhere from $3,296 to $37,227 for a routine vaginal delivery. For a C-section, the bills ranged from $8,312 to $71,000. And, to boot, discounts on these billed prices also vary widely from one insurance company to the next, further muddying the waters of what exactly you can expect to pay.
Your best bet is to negotiate well ahead of delivery with more than one hospital to get the best possible rate. At some hospitals, it’s possible to get a contract specifying your likely costs and perhaps an extended time to pay the bills. It’s often wise to start by calling the hospital ombudsman and getting directed to the right person. If you can’t or don’t want to negotiate, at least find out what each hospital in your area charges. Some doctors have privileges to practice at more than one hospital. So ask your doctor where she/he has contracts to practice and then check to see which of those hospitals give you the best financial option to deliver your child under your health plan.
4. Overlapping Plan Years
Most insurance plans follow a calendar year schedule, meaning your deductible, co-insurance and out-of-pocket reset back to $0 on January 1. Why is this important? Well, let’s say you are due at the end of January. You will have received the majority of your prenatal care in the previous year, meaning that everything you have paid out-of-pocket won’t apply to meet your out-of-pocket costs for your January delivery. A tongue-in-cheek tip: Consider conceiving around Valentine’s Day to keep costs limited to a single calendar year.
Pregnancy Costs You Should Expect
During your first and second trimester, you’ll have monthly check-ups with your doctor to monitor your weight, blood pressure and urine. In PPO plans, members are ypically required to pay a small co-pay for the check-ups. However, if you are in an HDHP and haven’t met your steep deductible, you will have to pay the full billed amount each month.
Routine Lab Work
During check-ups, doctors will draw blood to screen for birth defects, infections, your blood type, and Rh status. Like the monthly checkups, what you pay will depend on your plan. Like other medical costs, the amounts will depend on your insurance plan and where you live. As a general rule, routine blood work for pregnancy can run between $50 and $200.
Ultrasounds typically occur between weeks 16 and 20 of pregnancy. An ultrasound, also known as a sonogram, is a painless procedure that uses sound waves to show a grainy black-and-white picture of your baby in your uterus. The sonogram is used to check on the health and development of the baby as well as the position relative to the placenta. Earlier ultrasounds might be done to determine the viability of the pregnancy. Fetal ultrasounds cost $309 on average, according to the Healthcare Bluebook. Insurance coverage varies widely. Some insurance companies pay the full bill; others pay no more than 60%of the cost.
Cell-Free Fetal DNA Testing
This is a blood test done after10 weeks of pregnancy to determine if the baby has a chromosomal anomaly. Insurance plans are not required to cover this test, so check your plan to see if it’s covered.
Chorionic Villus Sampling
This test of the placenta can detect chromosomal anomalies and genetic diseases like cystic fibrosis, Tay-Sachs disease, and sickle cell anemia. It is performed at 10 to 13 weeks of pregnancy. Most plans cover it, especially for women over 35. But assume nothing, and check with your plan to be sure.
This screening is usually conducted in the second trimester to test for gestational diabetes. It is usually covered, but again check with your plan to be sure.The cost typically runs between $25 and $50.
Amniocentesis is a procedure that removes a small amount of amniotic fluid — the fluid that surrounds and protects the baby during pregnancy — from the uterus. Similar to chorionic villus sampling, this test is meant to identify if the baby has a chromosomal issue or genetic disease, such as cystic fibrosis, sickle cell disease, and Tay-Sachs disease. Doctors ask for it later in pregnancy, between weeks 15 to 20. It’s usually covered, again especially in women over 35. That’s important since this test usually starts about $1,500 and can go up to$5,000.
Delivery Expenses You Should Expect
It’s difficult to pinpoint the exact cost of delivery because of all the variables. Like, how long will your delivery last and will there be complications? Whatever happens, you should expect that the cost of medications, the epidural, anesthesiologist fees, the delivery room, and more will add up to bloat the final bill.
Your best bet is to address these variables when you try to negotiate a price with the hospital and your doctor ahead of time. Be sure to tell them who your insurer is so they can give you the discounted rate attached to your provider.
During your negotiations, of course, call your insurer for a rundown of your covered versus uncovered services and your financial obligations.
If you’re pregnant with another child or planning a family, it’s recommended that you save all you can to cover your out-of-pocket expenses. Also, keep careful track of all your bills to anticipate when you meet your maximum out-of-pocket amount, and your insurance company commonly starts paying 100% of your costs. But let’s face it, after your delivery, saving to cover your child’s expenses is at least an 18-year-old endeavor. You might as well start right away.