Wondering what your pregnancy will cost? You may be surprised to learn that there’s a huge range depending on where you live, how you give birth and whether you have insurance or not. Labor and delivery are among the most expensive health care costs in the United States, and without adequate coverage, they can run you tens of thousands of dollars.
The good news: Health insurance can greatly reduce those costs. Read on for insurance basics along with tips to reduce your maternity expenses.
Health insurance for pregnancy 101
Shopping for health insurance can seem as complex as doing your taxes — and it becomes even more complicated if you’re pregnant. So it first helps to understand the various health insurance terms you’re likely to hear:
- Premiums: The amount of money you’ll pay your insurance company monthly for coverage.
- Out-of-pocket cost-sharing: What you pay personally to your practitioner for medical visits and procedures as part of your health insurance plan.
- Co-pay: The amount of money you pay for each in-network doctor’s visit, which usually ranges from $25 to $50 (though if you have a high-deductible plan, you may only pay co-pays after you’ve met your deductible). Your insurance pays the rest of the bill.
- In-network co-insurance: The percentage you’ll pay toward your medical bills if you have a bigger procedure (like a C-section) at an in-network doctor or hospital (for example, your insurance may pay the first 70 percent, and you’ll pay the next 30 percent up to your out-of-pocket max).
- Deductible: The amount you pay before your health plan starts paying some share of the expenses. If your deductible is $3,000, you’ll pay for co-insurance out-of-pocket until you hit $3,000; at that point your health insurance starts paying for some of the expenses up to your out-of-pocket max, when they’ll start paying for everything.
- Out-of-pocket max: The most you’ll pay for covered services in a plan year. This amount does not count your monthly premiums but does include co-pays and coinsurance you continue to pay after you hit the deductible.
Since pregnancy is a high-cost health expense even for women with health insurance, you’ll want to especially focus on the cost of premiums and the coinsurance to keep your overall costs as low as possible.
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How much does pregnancy cost with health insurance?
You have several options for coverage of your pregnancy with health insurance,[1] 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 employer (or your spouse’s employer).
Here’s how costs usually break down:
Medicaid
If you’re pregnant and your family falls below a certain income threshold — in 2022 in Maryland, for example, it was $24,353 for a family of two — you can enroll year-round for Medicaid coverage with very little to no cost-sharing for maternity expenses.
A 2013 report by research firm Truven Health Analytics, The Cost of Having a Baby in the United States, estimated the average Medicaid out-of-pocket expenses for a pregnancy at less than 1 percent of the total costs.
Find out if you qualify for Medicaid using the Kaiser Family Foundation’s Medicaid and subsidy calculator or by calling 1-800-318-2596.
Marketplace coverage
Open enrollment for marketplace coverage usually starts around November and closes in mid-December. (Say, for example, you want coverage in 2024: You can sign up from November 1, 2023, until December 15, 2023.)
If you're already expecting or thinking about becoming pregnant and don't have healthcare coverage, it's a good idea to enroll during this period. Getting pregnant does not qualify you for special enrollment outside this period, but the birth of a child does.
There are four categories of Marketplace plans: Bronze, Silver, Gold and Platinum. (Catastrophic plans are also offered to some people.) From Bronze up to Platinum, the premiums go up, while out-of-pocket cost-sharing goes down (but never completely go away).
If your employer or your partner's employer doesn't offer health coverage, you may be eligible for subsidies to help pay for the cost of Marketplace insurance premiums if your income is up to 400 percent of the federal poverty level. That works out to $73,240 for a family of two and $92,120 for a family of three.
Employer coverage
The Kaiser Family Foundation notes that average premiums for employees of large firms are similar to the Marketplace ones for the Silver plan, though the coinsurance tends to be lower and the out-of-pocket maximums are sometimes lower.
A 2020 study published in the journal Health Affairs[2] found that for women with employer-based insurance, the average out-of-pocket cost of a vaginal birth increased from $2,910 in 2008 to $4,314 in 2015, with the cost of a C-section going from $3,364 to $5,161 during that same time period.
Pregnancy costs for the uninsured
While maternity expenses for insured moms might seem high, the numbers are far higher if you have no insurance at all. The Truven report put the uninsured cost of having a baby at anywhere from $30,000 for an uncomplicated vaginal birth to $50,000 for a C-section.
Those prices have increased dramatically in the last decade. According to the National Partnership for Women & Families, the cost of having a baby increased 50 percent between 2004 and 2010, and they’ve 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 concerned you won’t have enough money saved up to pay your bills by the time you deliver, your hospital may offer interest-free payment plan options, so contact their billing department to learn more.
How to reduce maternity costs
How can parents-to-be protect themselves from super-high medical bills (and sneaky surprises)? Here are some other ways to save on pregnancy costs:
- Plan ahead. Before you get pregnant, research the doctor or practice you would like to go to during your pregnancy, then make sure you are covered at that location and the hospital the practitioner is affiliated with. Interviewing OB/GYNs, family practice physicians, advanced practice nurses or midwives for a preconception consultation can help you feel prepared.
- Call your insurance company right away. Find out exactly what’s covered and what’s 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 whether it or a Marketplace plan would likely cost you less out-of-pocket for pregnancy. If you’re signing up for coverage through the Marketplace, compare costs online or call the insurer listed for more information.
- Opt for an HMO if one is available in your area. You can expect to pay the least out-of-pocket money if you choose an HMO, which limits you to specific doctors and hospitals — though you’ll typically have to pay a bit more in co-pay ($50 for an HMO vs. $30 for a PPO, for example) for each in-network doctor visit.
- Stay in-network. Avoid going outside of your network of doctors and hospitals, if possible, or you’ll pay more (as much as 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 $2,750 per person from your pre-tax annual salary, deducted in small portions from each paycheck. The tax savings are fairly small, but it does amount to a pretty painless savings plan — and you can access the full amount at any time.
- Ask questions. Any time your health care provider recommends an expensive test or procedure as part of your prenatal care, ask why it’s necessary and if there are other options.
- If you can, time it right. One thing to keep in mind if you aren't yet pregnant but are thinking about conceiving: If you get pregnant one year (say in June) and give birth the next (in March), you'll likely have to pay the deductible twice, which could be a sizable cost. Getting pregnant and delivering your baby within the same year (if at all possible) could bring some savings.
- Take advantage of services after birth. Under the Affordable Care Act (ACA), a number of health services — including breast pumps and lactation counseling after the baby is born — are mandatory and come at no cost to you.
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