Insurance and Giving Birth: What you Need to Know
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.
Key Takeaways
- You can expect to pay your deductible and possibly your out-of-pocket max for medical services related to giving birth.
- Using in-network providers can help reduce the cost of healthcare.
- Consider changing plans, if possible, to maximize your coverage before giving birth.
- Apply for pregnancy services through Medicaid if you meet the income limits.
4 Key Insurance Terms
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.
- In-network: Your health insurance company will designate a network of providers including doctors, specialists, labs, and hospitals as in-network. You’ll receive more coverage for these providers so they will cost you less money. Verify directly with your insurance company whether a provider you want to see is in-network.
- Out-of-network: Any provider not designated as in-network is considered out-of-network and their services will cost significantly more. If you have an HMO plan, seeing an out-of-network provider outside of an emergency may not be covered at all. Your specific plan will specify what percentage or rate you can expect to pay to see an out-of-network provider.
- Deductible: Your insurance deductible is the amount you will pay before your insurance kicks in for the year. Most plans have a separate in-network and out-of-network deductible as well as an individual or family deductible. When you give birth, you will most likely pay at least your deductible in medical expenses for the year.
- Out-of-pocket max: After you’ve hit your deductible, your insurance will cover a set percentage or rate for services and you will be charged the balance, up to your out-of-pocket maximum. Similar to the deductible most plans have an in network and out-of-network maximum as well as an individual and family out-of-pocket max.
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.
Birthday Rule
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.
Insurance Plan Features to Consider for Giving Birth
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:
- Whether the providers you want to use will be considered in-network in a new plan
- Deductible amounts
- Out-of-pocket maximum amounts, especially if you have a high-risk pregnancy
- Coverage for unique expenses in your birth plan like a midwife or a birth center
Medicaid Coverage for Pregnancy and Birth
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.
When Is the Best Time to Get Pregnant to Maximize My Insurance Coverage?
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.
When Is the Worst Time to Get Pregnant to Maximize My Insurance 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.
Can I Change Insurance Due to Pregnancy?
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.
Will Insurance Cover a Home Birth or Doula?
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.
The Bottom Line
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.
