Wondering how much your pregnancy will cost you? You may be surprised to learn that there is a wide range of prices depending on where you live, how you give birth, and whether or not you have insurance. Labor and delivery are among the most expensive health care costs in the United States and, without adequate coverage, can cost tens of thousands of dollars.
The good news: Health insurance can greatly reduce those costs. Read on for basic insurance information along with tips to lower your maternity costs.
medical insurance for pregnancy 101
Shopping for health insurance can seem as complex as doing taxes, and it gets even more complicated if you’re pregnant. so it’s helpful to first understand the various health insurance terms you’re likely to hear:
- Premiums: The amount of money you will pay your insurance company each month for coverage.
- Out-of-Pocket Cost Sharing: What you personally pay to your doctor for medical visits and procedures as part of your health insurance plan.
- Copayment: The amount of money you pay for each in-network doctor visit (insurance pays the rest of the bill), usually between $25 and $50 (although if you have a high-deductible plan, you can only pay copays after you meet your deductible).
- In-Network Coinsurance: The percentage you will pay of your medical bills if you have a larger procedure (like a C-section) at an in-network doctor or hospital (for example, your insurance you can pay the first 70 percent and you’ll pay the next 30 percent up to your out-of-pocket maximum).
- deductible: the amount you pay before your health plan begins to pay a share of costs. if your deductible is $3,000, you’ll pay coinsurance out of pocket until you reach $3,000; at that point, your health insurance begins to pay some of the expenses until your out-of-pocket maximum, when they will begin to pay for everything.
- Out-of-Pocket Maximum: The most you will pay for medical care in a year. this amount does not count your monthly premiums, but does include copayments and coinsurance that you continue to pay after you meet your deductible.
- plan ahead. Before you get pregnant, research the doctor or practice you’d like to go to once you get pregnant, then make sure you have coverage there and at the hospital where the doctor gives birth. Interviewing OB/GYNs, family practice doctors, advanced practice nurses, or midwives for a preconception consultation can help you feel prepared.
- call your insurance company right away. find out exactly what is covered and what is not. ask if you have to use a specific provider or hospital, what procedures and tests are covered, and how many days you can stay in the hospital.
- Know your out-of-pocket costs. If you’re signing up for private insurance through an employer, compare plans to see if it’s likely to cost less out-of-pocket for pregnancy, or a marketplace plan. If you sign up for coverage through the Marketplace, compare costs online or call the listed insurer for more information.
- Choose an hmo if one is available in your area. You can expect to pay the least amount of money out of pocket if you choose an hmo, which limits you to specific doctors and hospitals, although you will typically have to pay a slightly higher copay ($50 for an hmo vs. $30 for a ppo , for example) for each in-network doctor visit.
- stay in network. If possible, avoid going outside your network of doctors and hospitals, or you’ll pay more (up to 50 percent of the cost).
- open a flexible spending account (fsa). If your (or your partner’s) employer offers one, these special accounts allow you to set aside up to $2,650 per person ($5,300 if your spouse has the same option at work) of your annual salary before taxes, deducted on small portions of each paycheck. the tax savings are quite small, but they add up to a fairly simple savings plan, and you can access the full amount at any time.
- ask questions. Whenever your doctor or midwife recommends an expensive test or procedure as part of your prenatal care, ask why it’s needed and if there are other options.
- if you can, do it right. one thing to keep in mind if you’re not pregnant yet but thinking of conceiving: if you get pregnant one year (say June) and give birth the next year (in March), you’ll likely have to pay the deductible twice, which could be a hefty cost. Getting pregnant and delivering your baby within the same year (if possible) could result in some savings.
- Take advantage of services after the birth. Under the Affordable Care Act (ACA), a number of health services, including breast pumps and lactation counseling after your baby is born, are required and at no cost to you.
Because pregnancy is a high-cost health expense, even for women with health insurance, you’ll want to focus especially on the cost of premiums and coinsurance to keep your overall costs as low as possible.
how much does pregnancy cost with health insurance?
You have several coverage options, including Medicaid if you qualify; private insurance plans offered through your state or federal health insurance marketplace insurance through the Affordable Care Act (ACA); and private insurance through your (or your spouse’s) employer.
This is how costs are usually broken down:
if you’re pregnant and your family is below a certain income threshold (in 2020, in maryland, for example, it was about $35,000 for a family of two), you can sign up for medicaid coverage year-round with little or no cost sharing for maternity expenses.
A 2013 report from research firm Truven Health Analytics, The Cost of Having a Baby in the United States, estimated that the average out-of-pocket Medicaid costs for a pregnancy are less than 1 percent of total costs.
Find out if you qualify for Medicaid by using the Kaiser Family Foundation Medicaid & Grant Calculator or by calling 1-800-318-2596.
Open enrollment for Marketplace coverage typically begins around November and closes in mid-December. (Say, for example, you want coverage in 2021: you can enroll from November 1, 2020 through December 15, 2020.)
So if you’re pregnant or thinking about getting pregnant and don’t have health care coverage, it’s a good idea to sign up during this time. Getting pregnant does not qualify you for special enrollment outside of this period, but the birth of a child does.
There are five categories of market plans: catastrophic, bronze, silver, gold, and platinum. from catastrophic to platinum, premiums go up, while out-of-pocket cost sharing goes down (but never completely goes away).
If your employer or your partner’s employer doesn’t offer health coverage, you may be eligible for subsidies to help pay the cost of Marketplace insurance premiums if your income is up to 400 percent of the federal income level. poverty. that works out to $68,960 for a family of two and $86,880 for a family of three.
if you have private health insurance through your employer, a 2018 kaiser family foundation survey found that average premiums for employees of large companies are similar to the market for the silver plan, although the Coinsurance tends to be lower (80 percent is covered by insurance), and out-of-pocket maximums are sometimes lower.
a study published earlier this year in the journal health affairs found that for women with employer-sponsored insurance, the average out-of-pocket cost of a vaginal delivery rose from $2,910 in 2008 to $4,314 in 2015, with the cost from a C-section went from $3,364 to $5,161 during that same time period.
pregnancy costs for the uninsured
While maternity costs for insured mothers may seem high, the numbers are much higher if you don’t have any insurance. The Truven Report estimated the uninsured cost of having a baby at between $30,000 for an uncomplicated vaginal delivery and $50,000 for a C-section.
Those prices have risen dramatically in the last decade. According to the National Association for Women & For families, the cost of having a baby increased 50 percent between 2004 and 2010, and has likely increased more since then.
maternity costs can also vary from state to state by 50 percent and even more within some states, according to the truven report. A 2014 study by the University of California, San Francisco found that hospital charges for an uncomplicated vaginal delivery ranged from $3,296 to $37,227, depending on the hospital. for a C-section, costs ranged from $8,312 to nearly $71,000. You can see what the cost of delivery without health insurance might be in your ZIP code at fairhealthconsumer.org.
If you’re worried you won’t have enough money saved to pay your bills when you give birth, your hospital may offer interest-free payment plan options, so contact your billing department for more information.
how to reduce maternity costs
How can expectant parents protect themselves from sky-high medical bills (and sneaky surprises)? Here are some other ways to save on pregnancy costs: