Average Childbirth Costs & How to Pay With Health Insurance – ValuePenguin

When you’re pregnant, you may spend a lot of money on baby supplies and some prenatal care, but your biggest bills are likely to come shortly after the baby arrives: labor, delivery, and the medical care that comes with it. you and your newborn receive when you give birth.

here we will cover the average cost of childbirth, from the label price to the amounts allowed by health insurance plans. We’ll also show what types of services are included in the costs and explain how health insurance plans cover childbirth.

Reading: How much does insurance cover for childbirth

cost of delivery

in the usa In the US, the average cost of a vaginal delivery is $13,024, including standard pre- and post-delivery expenses like facility fees and doctor’s fees.

A cesarean section (C-section) is much more expensive, costing an average of $22,646, including standard expenses before and after delivery.

This cost of delivering a baby, totaling more than $10,000, is based on what the hospital charges. If you have health insurance, the amount you would pay for the delivery will be determined by the plan’s benefits. This includes the insurance plan’s deductible and copays, which can affect how much she would pay for doctor’s services and a hospital room, for example.

Please note that these average delivery costs assume no complications. But even with a typical birth, the amount a hospital charges can vary widely between facilities and locations. What the hospital charges for a vaginal delivery can fluctuate by more than $30,000 between states, and the cost of a C-section fluctuates by more than $50,000.

The cost of delivery also changes if you are considering alternative delivery methods. Some pregnant women are opting for an approach to childbirth that is different from the common medical version: less clinical and, hopefully, less expensive. You could use a midwife for maternity care, give birth in 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 that their share of costs at a birthing center or for a home birth with a midwife is in the $3,000 range. Insurance plans vary widely in how they cover midwives and birthing centers.

cost of delivery in hospital

nearly 99% of births in the us. uu. 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, or more if you’ve had a caesarean section (C-section). and you will usually need the services of nurses, anesthesiologists, and an obstetrician or midwife. You may have procedures such as fetal monitoring and postnatal care for you and your newborn. The costs of all these elements of a hospital birth add up.

Here’s a breakdown of what the cost of a routine hospital delivery might look like, based on a sample insurance plan on healthcare.gov:

how childbirth is covered by health insurance

Health insurers must cover maternity care and childbirth. This is one of the 10 essential health benefits required by the Affordable Care Act. only protected individual plans and short-term health insurance plans are exempt from this requirement. all other plans, including those found on any state exchange or federal marketplace; those offered by employers; and those offered for the first time after 2013, must cover these 10 essential benefits.

Health insurance plans can, and most do, require pregnant women to pay a portion of the costs of labor and delivery. But the Affordable Care Act makes it a little easier to understand exactly how this might work because it requires insurers to create a standardized summary of benefits (SBC) for each plan they offer. an example of standardized coverage in the sbc of each plan is having a baby with a normal delivery.

A nasty financial surprise for many new parents: Your newborn can start racking up his own medical bills from the moment he’s born. Family insurance plans may charge a deductible and out-of-pocket expense for each covered individual, including your new little dollar sign pack, up to a predetermined maximum.

Also, insurance plans vary widely in how they cover midwives and birthing centers, and specifically which providers are in-network, so check with your insurer before making this decision for your care. maternity.

how much will you pay to have a baby, with health insurance

The amount you’ll pay out-of-pocket for delivery costs will depend largely on whether or not you have health insurance and, if you do, the plan’s cost-sharing structure (deductibles, copays, and coinsurance). have. choose.

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If you have health insurance, you may have to pay your deductible for your hospital care when you deliver your baby. You may also have copays or coinsurance for things like drugs, medical services, or radiology.

Let’s use an example to illustrate the total out-of-pocket costs for a mom-to-be with health insurance coverage.

example of patient costs with deductibles and coinsurance

The table below shows how much it costs to have a baby under different insurance plans for someone living in Arlington, Virginia. the costs of the health insurance plan, pregnancy care and childbirth are included. medical costs are based on healthcare.gov’s calculation for the “cost of a healthy pregnancy and normal delivery.”

With a typical pregnancy, choosing a platinum plan could save you about $6,039 over the policy year, although the plan costs $144 more per month than a bronze plan.

In the cases shown in the chart, medical costs for a typical pregnancy and delivery do not reach the plan’s out-of-pocket maximum, which limits the amount a person would pay for medical care during the year.

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However, in a serious scenario where there are complications or other medical conditions to treat, medical costs could reach the plan’s out-of-pocket maximum. even if this happens, the platinum plan with its great benefits still leads to the lowest overall costs.

In a situation with labor complications, choosing a platinum-level plan could save you $3,000-$4,000 over the year.

questions to ask your health insurance provider

Call the number on the back of your card and ask things like:

Question: Are pregnancy and delivery costs capped at the individual level or will the full family deductible and out-of-pocket maximum apply?

In most cases, family insurance plans will have a deductible and out-of-pocket maximum for each individual and for all family members on the plan. this is significant because the cost of labor and delivery for a new mother is very high.

With most health plans, a mother’s costs will be capped at the individual level, with an out-of-pocket maximum of $8,700 for Marketplace plans. however, if expensive medical care is needed for other family members, your household expense may also reach the family out-of-pocket maximum, which cannot exceed $17,400.

Understanding how your insurance plan’s individual and family benefits work can help you better prepare for medical bills. Even if the mother has reached her individual spending limit, her family and the newborn could still have additional medical bills.

Question: Once I add my new baby to my plan, when will charges for her deductible, copays, and coinsurance begin?

Based on reports from women who have recently had a baby, some plans cover newborn hospital care based on the mother’s cost-sharing requirements until both are discharged from the hospital. others consider the baby a new individual member of the family from the date of her birth, when her bills accumulate toward her own deductible and cost share. These may include her hospital stay, doctor visits, and lab tests.

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Also, keep in mind that if you don’t already have a family plan, adding your baby may push you onto one, increasing your monthly premiums.

How your health insurer handles these issues can make a difference of thousands of dollars in your family budget.

give birth to a baby without health insurance coverage

If you do not have health insurance, you will be responsible for all the costs of prenatal care and the birth of your child. however, many states make it easy for pregnant women to enroll in medicaid or a state-sponsored health insurance program, through which all of their health care would be free or very low cost.

If you weren’t pregnant, you would have to earn less than $17,775 to qualify.

Those who cannot obtain coverage through a public program or through an employer can purchase a plan through the health insurance marketplace or directly from an insurance company. a market plan will generally be the cheapest because discounts are available for those with low to moderate incomes. however, there are time restrictions on when you can enroll in a Marketplace plan.

If you’re pregnant and don’t have insurance, you can only enroll in the Marketplace:

If you use the special enrollment period after delivery, the plan will not cover the cost of delivery.

To avoid being left without insurance when you give birth, you can also buy a health insurance policy directly from an insurer instead of through the marketplace. The monthly costs of a plan can be high, but they won’t be as high as paying full price to deliver the baby. Before you enroll, check your policy for current pregnancy coverage exclusions.

Also, we typically recommend avoiding short-term health insurance policies because these plans generally exclude pregnancy and childbirth.

If you don’t have health insurance during labor, you may be able to negotiate prices with your doctor and hospital. however, keep in mind that without insurance, your costs for a complicated delivery or critically ill newborn could run into the tens or even hundreds of thousands of dollars.

closing

It’s hard to get around the costs of childbirth. But if you’re pregnant or trying to conceive, take a hard look at your health insurance coverage options. Consider both your premiums and all the out-of-pocket expenses you’ll likely have to pay for your maternity care, from prenatal visits to ultrasounds and common prenatal tests, as well as the costs of labor and delivery. (don’t forget the newborn part!)

When faced with a large amount of expected health care, it may make financial sense to choose a plan with higher premiums if you’ll save money with lower deductibles and out-of-pocket maximums.

methodology

The average cost of delivery without insurance is based on ValuePenguin’s independent research of vaginal deliveries versus cesarean deliveries using hospital transparency data from the largest hospital systems in 39 states.

The average cost of childbirth for people with health insurance is based on marketplace health insurance plans offered in Arlington, Va., with averages of the 53 plans offered by Bright Health, Cigna, Kaiser Permanente, Innovation Health, and unitedhealthcare.

Additional sources include the US Agency for Healthcare Research and Quality. uu. department of health and human services (hhs), california department of health care services (dhcs), and healthcare.gov.

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