How Much Your Pregnancy Will Really Cost You
With or without insurance, you can get hit with a sky-high hospital bill after delivering baby. Here's the scoop on how to keep your healthcare costs down.
We wish we could give you a firm number, but prenatal health care and delivery costs vary radically. How much you’ll pay will depend on factors like where you live, whether you have any complications and whether you have a vaginal birth or a c-section. But here are some ballpark figures: Prenatal care and delivery costs can range from about $9,000 to over $250,000 (quite a range, huh?). But before you freak out, know that we’re talking without insurance. With health insurance, the bulk of these expenses could be covered — but that’s not always true.
I have health insurance. What should I expect to pay for prenatal care and delivery?
Policies that cover maternity costs
Good news: If you have insurance provided by your employer and the company employs at least 15 people full-time, your insurance must provide maternity services.
The percentage of prenatal and maternity costs that will be covered depends on your insurance carrier and which plan you have, but typically, employee plans cover between 25 percent and 90 percent of costs. Keep in mind that this is after the deductible has been met and that there may be a separate deductible for each family member, so you’ll likely be paying a bit more than that out of pocket. In other words, if each family member (including your newborn baby) has a $2,000 deductible, you’d have to pay the first $4,000 of expenses for both your and baby’s medical care, plus whatever else your plan doesn’t pay for.
If you have a plan through the Affordable Care Act, it will cover pregnancy and childbirth — yes, even if you were pregnant before you got the coverage.
Policies that don't
If you have an individual insurance policy, which isn’t provided through your employer, odds are it won’t cover maternity costs. Several states mandate that plans cover prenatal and delivery costs, but most states don’t require that they do. In 2010, just 12 percent of individual policies offered maternity coverage. Often, it’s possible to buy a rider to cover maternity expenses, but the cost for that can be high (up to $1,100 a month), and sometimes there’s a waiting period of one or two years before the benefit can be used.
How can I make sure my health insurance provider pays for as much as possible?
To avoid paying extra or for something you shouldn’t have to, it’s important that you thoroughly understand your insurance carrier’s maternity coverage policy. If you have insurance through your employer, your human resources department should be able to help you understand your coverage. Most carriers also have a pregnancy hotline you can call to find out all the details. Follow these tips to ensure maximum coverage and minimum sticker shock:
Choose an OB and hospital or birthing center that’s “in-network” to avoid out-of-pocket costs.
Understand your insurance plan.
Find out the deductible, copay and out-of-pocket maximums to estimate what your costs will be.
Don't stay too long at the hospital.
Check the length of hospital stay that is covered and only stay that long, if possible.
Notify your carrier of baby's birth asap.
Many plans require that a new baby be added to a family’s insurance policy within 30 days of birth. If not, your baby’s expenses may not be covered. Some even expect you to call them when you get to the hospital to deliver, and if you don’t, they may refuse to cover the cost of your delivery and your baby’s hospital care.
How can I get health insurance if my (or my partner’s) employer doesn’t provide it?
Individual health insurance may be an option, but look closely at your choices, since the plans usually don’t cover maternity costs and sometimes legally treat pregnancy as a preexisting condition (which means it might not be well-covered). You may qualify for a federal or state health insurance program. A few that are available:
This federally funded program provides medical assistance to low-income families and individuals. Kathleen Stoll, deputy executive director of Families USA, recommends that women explore this option even if they don’t think that they’ll qualify. “Income eligibility levels are higher for pregnant women, so don’t assume that you’re not eligible,” she says.
State health insurance programs
These are offered in several states. Qualifications vary from state to state.
It facilitates federally funded health centers that provide basic medical care, including prenatal care on a sliding scale fee basis. And, as we mentioned above, it covers pregnancy costs.
This program offers continuation of health coverage to individuals and families who lose their health benefits because of job loss or other qualifying circumstances.
For help finding out more about private insurance options, check out the Plan Finder.
What are some ways to reduce my prenatal and delivery costs?
“Unlike in an emergency medical situation, you can be a smart shopper. You can do some shopping ahead of time because you have lead time,” says Stoll. Look for a hospital that offers good rates for delivery and postnatal care (yes, you can ask), and see if it's considered in-network for your plan.
Consider other settings.
If you anticipate an uncomplicated birth, consider using a birthing center instead of a hospital. The costs will range from about $3,000 to $4,000, which is about half of what a hospital birth would cost. Just know that the birthing center may not be considered in-network, so you could end up paying more out of pocket than you would at an in-network hospital. For a home birth, usually all costs are 100 percent out of pocket, but they're usually much less costly.
Negotiate with your hospital.
Find out if the financing department of the hospital where you’ll deliver offers discounts for uninsured patients or if it will work with you to set up a payment plan.
Take generic medications.
“Work with your OB to explore if there are generic alternatives to drugs prescribed during prenatal or postnatal care. You may also be able to take over-the-counter prenatal vitamins instead of prescription ones,” says Stoll.
Plus, more from The Bump: