Insurance and Giving Birth: What you Need to Know – Investopedia
Insurance can help defray much of the cost of giving birth, but you may still face a significant bill for hospitalization and other medical services.
Even with insurance, the average out-of-pocket cost of giving birth ranges from about $2,700 to $3,200 depending on whether you need a cesarean section, according to a recent Kaiser Family Foundation study. Several factors can affect the cost of giving birth, from where you live to which provider you use. Learn more about the role of insurance in giving birth, and about how you can potentially reduce your costs.
Health insurance plans are typically either a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). Coverage can vary depending on the type of plan you have and other factors. Understanding the following terms can help you review your plan’s details and make decisions that could save you money.
You could potentially have to pay beyond the out-of-pocket maximum if your insurance denies coverage for a service it deems medically unnecessary. For example, your insurance could potentially deny coverage for anti-nausea medication not covered in its policy. If these cases, you can appeal the decision and try to get the service or medication covered.
If each parent has their own health insurance, the child is covered under the insurance of the parent whose birthday falls earlier in the year. This is called the birthday rule. If you and your partner both have health insurance separately, consider if the parent with the better coverage has a birthday later in the year. If possible, it may save you money if you switch to both being on the better coverage, even if the premiums are more.
In some cases, a different insurance plan can provide better coverage for giving birth. If you have the ability to change your plan before giving birth, consider these key factors:
Depending on your income, you may qualify for Medicaid services related to pregnancy and childbirth that can save you money. You can review the income limits for your state on Medicaid’s website. Remember to include the child you’re expecting in your household size.
In terms of maximizing insurance coverage, December is an ideal month to get pregnant. Most prenatal visits don’t start until you’re 6 to 12 weeks pregnant. So, with a December pregnancy, you can receive services starting in a new year and give birth before the year is over. That way, you can best utilize your out-of-pocket maximum to receive more coverage.
Conceiving in March or April would potentially give you a due date of late December through January. Going into the hospital with complications on Dec. 30 and not giving birth until Jan. 1 of the following year would likely result in you paying two deductibles for two different years of coverage. You could also potentially face two different out-of-pocket maximums instead of one, which would double your medical costs.
You can’t change insurance due to pregnancy, but you can enroll in Medicaid or pregnancy coverage Medicaid if you meet the income limits in your state. Keep in mind that you can change plans during open enrollment, so research your options if you’ll can switch insurance providers before giving birth.
Whether insurance will cover a home birth or doula will depend on your specific insurance policy. Most insurance policies don't cover home births or doulas. Contact your insurance company to see what is covered. You may have the option to fill out paperwork from a doctor saying your doula is medically necessary.
Pregnancy coverage and giving birth is often expensive in the U.S., even with insurance. If you understand your insurance options, you can potentially save money with a plan that can provide the most for your needs. Consider consulting a financial advisor to guide you through the process of selecting the best insurance policy for your situation.
Kaiser. “Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care,”
Healthcare.gov “How to Appeal an Insurance Company Decision,”
CT.gov. “The Birthday Rule,”
Medicaid.gov. “Medicaid, Children’s Health Insurance Program & Basic Health Program Eligibility Levels.”
HealthCare.gov. “Qualifying Life Event (QLE).”
Centers for Disease Control and Prevention. “Births: Final Data for 2020,” Page 2.
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