Jeffrey Wade
Pregnancy and childbirth are costly, and health insurance can help mitigate these costs. In the United States, as of 2020, the average cost of childbirth – from pregnancy to delivery and postpartum care – was $18,865. Fortunately, most health insurance plans cover prenatal care, childbirth, newborn care, and breastfeeding services. However, it is important to note that coverage may vary depending on the specific plan and insurer. For those without insurance, there may be free or discounted services available, and government programs like Medicaid and the Children's Health Insurance Program (CHIP) can provide free or low-cost coverage for pregnant women and their newborns.
| Characteristics | Values |
|---|---|
| Does medical insurance cover childbirth? | All major medical insurance plans cover pregnancy and childbirth. |
| What are the exceptions? | Grandfathered individual health plans are not required to cover pregnancy and childbirth. Large-group health plans do not have to cover labor and delivery costs for dependents. Short-term health insurance or fixed indemnity plans do not have to include maternity coverage. |
| What are the costs? | The average cost of childbirth in the US as of 2020 was $18,865. The average out-of-pocket cost for people enrolled in a large-group health plan was $2,854. |
| What are the alternatives if someone doesn't have insurance? | There may be free or discounted services for expecting mothers. There are also government health insurance programs like Medicaid and the Children's Health Insurance Program (CHIP) that provide free or low-cost health coverage. |
| What are the factors affecting the costs? | The factors include where one lives, whether there are any delivery complications, the specifics of the health plan, and the type of delivery. |
| What are the additional services covered? | Most health insurance plans cover prenatal care, newborn care, and breastfeeding services. Some plans may also cover infertility treatments. |
| Are there any international programs? | The European Health Insurance Card provides coverage for childbirth and other healthcare services in the EU/EEA and Switzerland. |
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What You'll Learn
Prenatal and postnatal care
Prenatal care covers all the care you get from the time you find out you're pregnant to the actual delivery of your baby. This includes prenatal check-ups, ultrasounds, and tests. Some prenatal genetic testing may not be considered a routine test and might require additional payment. It is recommended to contact your health insurance company to understand what specific procedures are covered in your plan.
Postnatal care includes the costs of well-mother visits and tests, newborn care, and breastfeeding equipment. If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year. You can also explore other options like the Children's Health Insurance Program (CHIP) or hospital indemnity policies, which may offer free or discounted services for expecting mothers.
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Inpatient services
In the case of Medicaid, if you are eligible, you will be covered for at least 60 days after giving birth, and some states offer coverage for a full 12 months. Additionally, if you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year.
For those without insurance, there may be free or discounted care options available, including government health insurance programs such as Medicaid or the Children's Health Insurance Program (CHIP). These programs provide free or low-cost health coverage to millions of Americans, including pregnant women, and the eligibility criteria depend on household size, income, and citizenship or immigration status.
It is always advisable to review the Summary of Benefits and Coverage documents provided by insurance plans to understand the specific coverage for inpatient services related to childbirth.
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Breastfeeding services
The National Women's Law Center has a Breastfeeding Toolkit that explains insurance coverage for these services. Women who encounter problems with this coverage can call the CoverHer Hotline for free assistance.
The type of breastfeeding services covered by insurance may include lactation consultant visits. For example, many Aetna plans cover up to six visits with a lactation consultant. Additionally, health insurance plans must cover the cost of a breast pump, although there may be guidelines on the type of pump covered and whether it is received before or after the baby's birth.
It is important to note that some insurance plans may not be subject to the women's preventive breastfeeding services requirements under the Affordable Care Act. These include grandfathered plans or plans that are otherwise exempt. Therefore, it is recommended to review the Summary of Benefits and Coverage documents provided by health plans to understand the specific breastfeeding services covered by your insurance plan.
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Infertility treatments
However, it's important to note that even in these states, there may be exemptions for self-insured employers or religious organizations. Additionally, the definition of infertility and the specific treatments covered can vary significantly from state to state. For example, Arkansas law stipulates that a patient's eggs must be fertilized with their partner's sperm, excluding LGBTQIA+ couples and single parents.
In terms of insurance coverage, it depends on the specific plan and the state. Some plans only cover tests, while others include IVF cycles. Generally, state-regulated health plans are more likely to cover fertility preservation before a medical treatment that could harm a person's fertility and the diagnosis of infertility. However, plans that include IVF coverage are less common.
In California, insurers that offer group health plans must offer coverage for at least some infertility treatments, but employers decide whether to provide this benefit to their employees. Similarly, in New York, large group health plans are required to cover up to three IVF cycles, but small group insurers are not mandated to cover IVF.
It's always important to check the specific coverage details of any plan and be aware of potential exclusions or lifetime maximum benefits.
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Home births
The cost of a home birth can vary depending on where you live and the type of medical care you need. The cheapest cost for a home birth is about $2,000, while the most expensive is about $10,000. On average, a home birth costs $4,650, but you may pay more if you need more in-depth care during labor or delivery. If you need to be transported to a hospital, you will also have to pay the charges for the care you receive there.
Some insurance companies do cover home births, and this is becoming more common. For example, UnitedHealthcare covers home births attended by licensed midwives, and WellPoint covers midwife services, though the coverage varies according to your location and health plan. Some Cigna plans cover home birth as long as you are accompanied by a licensed home birth care provider, and Excellus Blue Cross Blue Shield plans, which are available in New York, have similar requirements. In California, Medi-Cal has recently begun contracting with Certified Professional/Licensed Midwives, and Kaiser Permanente, one of the biggest HMO systems, employs Certified Nurse Midwives who often work for birth centers and attend home births. Only a few states, including New Hampshire, New Mexico, New York, and Vermont, require insurers to cover home births.
If your insurance plan does not cover home births, you will have to pay for the midwife and medical care yourself. However, some midwives offer self-pay discounts and flexible payment plans for clients who are not able to use their insurance or who do not have health insurance. If you are considering a home birth, it is best to talk to your insurance company early in your pregnancy to give yourself as much time as possible to find out what your options are. You should also talk to your midwife or healthcare provider to ensure that they have the necessary malpractice insurance to be eligible for reimbursement from health insurance plans.
If your insurance carrier denies your request for coverage for a home birth, you can submit a formal appeal. You can argue that the choice of where a person gives birth is a basic human right, and that an out-of-hospital birth would be less expensive than a hospital birth.
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Frequently asked questions
In the US, all major medical insurance plans cover pregnancy and childbirth. This includes prenatal care, inpatient services, postnatal care, and newborn care. However, it is important to note that coverage may vary depending on the specific plan and some plans may not cover non-traditional births.
Some insurance plans may consider home births or the use of midwives as "not medically appropriate" and will not cover them. It is important to check with your insurer if you plan on having a non-traditional birth.
If you do not have medical insurance, you may be able to receive financial assistance through government programs such as Medicaid or the Children's Health Insurance Program (CHIP). Additionally, there may be free or discounted services for expecting mothers in your area.
It is important to review the Summary of Benefits and Coverage document provided by your insurance plan. This document will detail how your specific plan covers the cost of pregnancy and childbirth, including any out-of-pocket costs or limitations.
