Ask any parent, and they’ll say the birth of their child was the most memorable moment in their lives. But for many parents, it’s a time of financial stress because they don’t have adequate healthcare. A negative or stressful childbirth experience has adverse effects on the entire family.
This is why health insurance is crucial when you’re starting a family. But what is the cost of childbirth, and how do you find the right insurance plan for your specific pregnancy and childbirth needs?
You might be trying to start a family but are still deciding about insurance. You may already be expecting a new family member and need to know your options. Either way, the article below outlines what your insurance may cover during this happy event.
Maternity Coverage: What’s Included In Your Insurance Plan?
The good news for everyone starting their family is that, under the Affordable Care Act (ACA), all major medical insurance plans offer maternity coverage.
This includes prenatal care, inpatient labor, childbirth services, postnatal care, and newborn care. However, the degree to which the costs of these services are covered may vary.
Unpacking Pregnancy And Childbirth Insurance Coverage
Your insurance must cover prenatal care and childbirth, but the different stages of your childbirth journey have different requirements.
You may need to be induced or have a C-section if you’re identified as a high-risk pregnancy. Check if your insurance covers this. Without insurance, you may find the costs unmanageable.
Prenatal care is a set of healthcare services and support provided to pregnant individuals to ensure a healthy pregnancy and the well-being of both the mother and the developing fetus.
Prenatal care typically includes the following components and services, which may be covered under health insurance:
- Ob-gyn visits
- Prenatal vitamins – available over the counter, subject to a copay on prescription
- Early Ultrasound
- Cell-free fetal DNA testing
- Chorionic villus sampling, or CVS
- Ob-gyn visits
- Maternal blood screening
- Glucose screening
- Ob-gyn visits
- Birthing classes
The type of birth affects what your insurance will cover. Although all health insurance plans cover childbirth, this usually means a hospital birth. Ensure that your insurance covers other delivery forms if you are or anticipate a high-risk pregnancy.
Labor And Delivery
ACA-compliant medical insurance covers the labor process and natural birth in a hospital or registered childbirth clinic. However, where you receive your maternity care and give birth may be an issue if you’re on a health plan with an exclusive or preferred provider network.
C-Section Birth: Insurance Implications And Coverage
A caesarian section delivery (better known as a C-section birth) is often medically necessary. ACA plans cover C-section births, but because they are more expensive than vaginal births and require a longer hospital stay, you may face more out-of-pocket costs.
While some health insurance plans cover home births and midwife or doula services, many do not. You may have to pay these costs out-of-pocket.
Understanding Hospital Charges
Childbirth-related hospital charges can vary significantly from one facility to the next. These costs fall into two categories – those related to care for the mother and those for newborn care.
Costs For Mothers
Hospital costs for a mother during and after childbirth can vary depending on the type of delivery, length of the hospital stay, the hospital’s location, and the specific services provided. Here are some common components of hospital costs associated with childbirth:
- Labor and Delivery Room: This includes the cost of using the labor and delivery room, monitoring equipment, and medical supplies.
- Operating Room (if needed): If a cesarean section (C-section) or any other surgical procedure is required, the cost of the operating room and associated services will be included.
- Medical Staff: This includes the fees for obstetricians, midwives, anesthesiologists, and nurses who provide care during labor, delivery, and immediately afterward.
- Medications and Anesthesia: Costs for pain relief, anesthesia, and any drugs administered during childbirth.
- Laboratory and Diagnostic Tests: Charges for any lab work, blood tests, or diagnostic tests that are conducted during or after childbirth.
- Room and Board: The cost of the hospital room, meals, and general nursing care during your stay.
- Postpartum Care: This includes the care and monitoring provided to the mother and baby in the immediate postpartum period.
- Use of Equipment: Any specialized medical equipment used during childbirth and recovery.
- Incidentals: Charges for items like disposable supplies (e.g., gowns, diapers), toiletries, and other miscellaneous items provided by the hospital.
- Complications or Additional Services: If there are complications during childbirth or if additional medical services are required, these will also add to the overall cost.
It’s important to note that insurance coverage, including Medicaid or private health insurance, can significantly affect what the mother will have to pay out of pocket. The specific details of insurance coverage, deductibles, copayments, and any out-of-pocket maximums will determine the final cost to the mother.
Post-natal care like breastfeeding counseling, provision of breast pumps, and screening for post-natal depression may also be included under an ACA plan.
Costs For Newborns
After a newborn’s birth, various costs and expenses are associated with their care. These costs can vary based on the baby’s health, location, and circumstances. Here are some typical costs associated with a newborn after delivery.
- Hospital Charges: This includes charges for the newborn’s care immediately after birth, encompassing routine exams, tests, and screenings.
- Delivery Room and Nursery Fees: Charges related to using the delivery room, nursery, and any special care unit for newborns.
- Newborn Screenings: Costs for screenings and tests performed on the newborn shortly after birth, such as hearing and metabolic screenings.
- Vaccinations: Fees for vaccinations and immunizations that may be administered during the hospital stay or shortly after birth.
- Consultations with Pediatrician: Costs for initial consultations with a pediatrician and any follow-up appointments that may be necessary.
- Medications: Charges for any drugs or treatments prescribed for the newborn.
- Supplies and Equipment: Costs for essential items like diapers, baby clothing, blankets, and any specialized equipment or medical supplies that may be required.
- Postpartum Care for Mother: While not directly related to the baby, costs associated with the mother’s postpartum care, including follow-up appointments, should be considered.
- Insurance Deductibles and Copayments: Any out-of-pocket expenses related to the newborn’s care as determined by the family’s health insurance plan, including deductibles and copayments.
Newborn care costs cover the first 30 days of your baby’s life from the time of birth. Your insurance policy covers them during that time. After this period, you must add your baby as a dependent on your policy.
Out-of-Pocket Expenses For Childbirth
The US’s average cost of pregnancy, childbirth, and postpartum care is well over $18,000.
Much depends on the state you’re in, the facility you give birth in, and whether you face any complications during the birth. To avoid an overwhelming expense, getting medical insurance coverage before getting pregnant is best.
As with any medical procedure, childbirth can carry out-of-pocket costs. The average out-of-pocket cost for vaginal births with health insurance is $2,655, while cesarean deliveries can be as high as $3,214.
Doctor And Hospital Networks
Does your health plan have an exclusive or preferred provider network? If you go outside that network for maternity care or childbirth, you’ll have high out-of-pocket costs or have to pay for the services yourself.
In an emergency, you won’t be penalized for going to your nearest emergency medical center, whether they’re part of the network or not.
Affordable Maternity Health Coverage
ACA medical plans can be subsidized. To qualify, you’ll need to meet income criteria, but even households with no income can access ACA-compliant medical care during pregnancy and childbirth.
Besides the ACA plans, Medicaid and the Children’s Health Insurance Program offer maternity coverage. These joint federal and state programs offer maternity coverage to eligible pregnant women who can’t afford insurance. You may still qualify for CHIP if you don’t qualify for Medicaid. Some community clinics and welfare programs may offer maternity services as well.
You need good health insurance to have a safe and happy pregnancy and childbirth experience. Enhance Health has helped people nationwide get health insurance for their growing families. And we’re confident we can do the same for you.
Whatever your family’s development stage, you can trust us to find insurance that works for you. As an approved ACA insurance broker, we cut through all the confusing jargon and simplify health insurance sign-up. Call us today and get the coverage you need.