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This post originally appeared on Amino.
Getting pregnant is a whirlwind experience—and an expensive one! From pregnancy itself to delivery and everything that comes after, there are a lot of costs you’ll have to budget for.
Having a baby might be one of the most expensive healthcare costs you experience. However, despite the fact that there are nearly 4 million babies born annually, it can be difficult to find clear information about the cost of delivering a child. A 2015 Health Affairs study found that hospital costs for women who had no risk factors to complicate childbirth ranged from less than $2,000 to $12,000 or more.
From your insurance to your health, there are a lot of different things that might affect how much you’ll pay out-of-pocket to deliver your baby. This post outlines some of the most important factors—but keep in mind that every pregnant woman’s experience is going to be slightly different.
The Affordable Care Act (ACA) mandates coverage for prenatal and postpartum care. This means that your insurance plan should cover the majority of costs for everything from prenatal appointments to newborn care right after your baby is born—but not necessarily the hospital and delivery fees for labor.
These covered costs include the following preventive care services for pregnant and postpartum women:
Routine anemia screenings
Folic acid supplements
Gestational diabetes screening
Hepatitis B screening
Rh incompatibility screening
Urinary tract infection screening
Breastfeeding support and counseling
The postpartum care services for newborns include:
Behavioral assessments and developmental screenings
Blood pressure screening
Gonorrhea preventive medication
Height, weight, and body mass index
Hematocrit or hemoglobin screening
There's been a lot of talk lately about the ACA potentially being repealed, so you'll want to pay attention to the news over the coming weeks and months to see how a repeal would affect the currently covered procedures. Plus, even if a repeal doesn't happen, it's important to know that not all insurance plans, doctors, and hospitals follow the current ACA policies to a T, so you’ll have to appeal to your insurance plan if you’re getting charged for something that’s featured on the list above.
You should also take note that many insurance companies exclude ultrasounds from the list of services covered under the ACA. According to United Healthcare, which is a major US insurer, "Prenatal services not covered under the women’s preventive coverage include, but are not limited to, radiology services, delivery and high-risk prenatal services. While radiology services like obstetrical ultrasounds may be part of routine prenatal care, they are not included under the health reform law. A copayment, coinsurance or deductible may apply for these services."
When it comes to labor and delivery charges, your health insurance plan—including your premium, deductible, co-pay, and co-insurance— is a good starting point for figuring out your out-of-pocket costs.
The premium is the amount you (and/or your employer) pays each month to keep you insured;
Your deductible is the amount you’ll have to spend out-of-pocket before insurance kicks in;
Your co-pay is the fixed amount that you’ll pay for certain services and office visits after your deductible kicks in;
Your co-insurance is the percentage of the bill (from your doctor or hospital) that you have to pay, even after you hit your deductible. For example, if you have a 20% co-insurance, you’ll be responsible for paying 20% of your hospital bill, even if you’ve already paid your deductible.
If you’re pregnant or planning on getting pregnant soon, it’s ideal to choose a health insurance plan with a lower deductible and lower co-insurance to minimize your out-of-pocket costs for hospital visits. Online insurance marketplace PolicyGenius recently published a great article that reviews these basic concepts and explains how to pick the right plan while you’re pregnant.
PolicyGenius CEO Jennifer Fitzgerald adds, "Most health insurers will offer you an estimated cost breakdown of pregnancy costs in their plan details. Once you've narrowed your plan choices down, dig into the policy details and cross compare specific pregnancy costs before making your final decision."
As you decide which doctor you want to deliver your baby and which hospital you want to go to, you’ll need to consider the role your insurance plays.
Find an in-network doctor. Choose an OB/GYN that’s in-network—that is, covered by your insurance plan.
Understand your doctor’s hospital affiliations—and make sure the hospital is also in-network. Doctors have hospital affiliations that affect where they can deliver your baby. Be sure to choose a doctor that is affiliated with a hospital that is also in your insurance network. If you get out-of-network care, you could get stuck with a large medical bill (which is the last thing a new parent needs).
Ask the hospital if all the doctors you’d interact with, including the anesthesiologist, are in-network. Call the hospital and make sure that the healthcare providers you’ll interact with while at the hospital will be in-network — especially the anesthesiologist, if you’re planning on getting an epidural. Many hospitals have anesthesiologists on staff that aren’t part of the same insurance network, so you’ll want to double check.
Locate an ER and urgent care center nearby. Another smart move is to find an urgent care center and/or emergency room nearby that’s also in-network, in case something happens during your pregnancy — out-of-network emergency room bills can be extremely pricey.
While finding a doctor and hospital that take your insurance is high priority, there are a few other factors that can help keep costs down and make you feel confident about your choice in care. A few big things to consider aside from being in-network: the doctor’s experience treating people like you, and your doctor and hospital’s predicted C-section rate.
When you’re bringing a life into the world, it’s important to trust the people helping you. If you’re having twins, have gestational diabetes, preeclampsia, or another type of complications during your pregnancy, finding an OB/GYN who has experience treating people in your situation is a high priority. Research shows that experience matters—not necessarily years of experience practicing medicine, but rather the number of patients a doctor has treated with your condition.
But experience is very difficult to measure. That’s where Amino comes in. We're a free service that helps you find a doctor and estimate healthcare costs. By stitching together years of data from health insurance claims (the records doctors send to insurance companies to get paid for what they do), we've built the most comprehensive database of healthcare experiences. This is what powers Amino’s search results—you can search for things like gestational diabetes, preeclampsia, or just pregnancy in general, answer a few questions about yourself, and get matched with an in-network doctor based on his or her experience treating similar patients.
Another factor you should consider is how you want to deliver your baby. Some women want a vaginal birth, while others might want or need a C-section. Whether or not you opt for a C-section is a personal decision; C-sections require longer recovery time, are riskier, and more expensive than vaginal births. According to the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, the average vaginal birth costs $2,900 without complications, and C-sections cost $4,500 or more (note: the data from that study is from 2008).
When it comes to C-sections, it’s hard to find cost and quality information together online. According to Jill Arnold, a consultant on consumer engagement in maternity care and founder of CesareanRates.com, "Without pairing information on quality measures—such as hospital C-section rates and episiotomy rates—with an out-of-pocket cost estimator, consumers don’t have the opportunity to make the connection between facility and provider fees and rates of procedures performed."
That means it’s hard to make an informed decision when you’re choosing where to deliver. "A patient intending to deliver vaginally might choose a hospital with lower average published costs without realizing that the hospital or provider has a C-section rate three times higher than their competitor for similar patients," Arnold said.
Even if you plan on giving birth vaginally, you should mentally and financially prepare for the possibility that you’ll need a C-section. If you’re interested in understanding your personal risk of C-section, your doctor’s predicted C-section rate, and your hospital's C-section rate, here are a few resources:
Check out Amino’s C-section predictor tool, which is based on your personal health factors.
Search for "pregnancy" on Amino to see the predicted C-section rates of OB/GYNs in your area.
Visit The Leapfrog Group’s hospital compare site to see hospital safety scores and C-section rates (click on the "Maternity Care" filter for C-section rates specifically).
Check CesareanRates.com for hospital C-section rates by state to see how hospitals in your area stack up.
Medicare’s Hospital Compare tool can also help you compare hospitals to determine their safety score.
You want to be prepared for having a baby and for the costs associated with it. Knowing what’s typical or average can help, but there are some things that just can’t be predicted. What happens at the hospital during your baby’s birth affects your total out-of-pocket costs, and no matter how well you plan, certain situations can cause your medical bills to range from a couple hundred dollars to tens of thousands of dollars. Some of these include:
Premature birth — this is one of the largest game-changers in terms of medical costs, occurring in about 1 of 8 pregnancies. The average healthcare for premature and low birth weight infants is nearly 11 times more costly than that for newborns without complications, according to a Thomson Reuters study for March of Dimes.
Whether or not you have an epidural — if you have an epidural, you’ll be looking at charges for the medicine and for the anesthesiologist (as stated above, anesthesiologists can often be out-of-network, so check in advance if an epidural is in your birth plan).
Whether or not you have a C-section — see above; C-sections, on average, are more expensive than vaginal births.
Unnecessary testing and monitoring during labor — for example, the continuous monitoring of your baby’s heartbeat during labor. According to Choosing Wisely, continuous monitoring is more likely to cause "false alarms" and unneeded procedures. For example, women who have continuous monitoring during labor are twice as likely to have a C-section.
Other health problems — sometimes unanticipated medical conditions arise during pregnancy and lead to hospitalization, emergency procedures and preterm birth—all of which can substantially increase costs.
Unplanned (and somewhat ridiculous) charges — you might see some outrageous charges on your bill, for example, your hospital charging for facilitating skin-to-skin contact with your baby. You can try contacting your health insurance company if you believe you’ve been charged unfairly.
When you’re pregnant, you’ll want to consider how your and your baby’s health may affect the total cost of giving birth. Health conditions like diabetes, obesity, and hypertension can increase complications and delivery costs.
For example, a delivery stay costs an average of 55 percent more for a woman with diabetes, according to the Agency for Healthcare Research and Quality. Plus, the average cost of hospital prenatal and postnatal care is higher for overweight mothers than for normal-weight mothers, and infants of overweight mothers require admission to neonatal intensive care units more often than infants of normal-weight mothers do.
For women 35 and over, having a baby comes with some increased risks. Certain additional tests and procedures (like amniocentesis) are sometimes recommended, which means extra costs. For more information, check out this guide.If you’re concerned about your baby having health problems, you can have prenatal and genetic testing done. The cost depends on what your insurance covers and what you are comfortable paying out of pocket.
As you plan your finances for having a baby, you’ll want to be clear on what is and isn’t covered by your insurance. It’s also a good idea to do enough research to ensure you’re getting the most (and best) care possible.
Check with insurance. Ask your insurance company about your costs like co-insurance, copays, and how much of your deductible you have left. Get specific information about which costs are covered and which are not.
Look for hospital bill errors. After you give birth, check your hospital bill for errors by using a service like Copatient. [Note: Copatient has seince rebranded as Mebex.] These services can help you reverse errors and get reimbursed.
HSAs, FSAs, and HRAs. If you have these types of accounts, use them—and consider opening an account if you don’t have one already. You can put pre-tax dollars into Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), and Health Reimbursement Accounts (HRAs) to help you cover out-of-pocket expenses.
If you don’t have insurance, have a conversation with your doctor. Some doctors will offer a discount or an interest-free payment plan if they know that you’re shouldering the cost on your own, and many hospitals offer financial aid for families with no insurance. Be sure to check with your hospital to see if you qualify for assistance through Medicaid. It’s worth asking because nearly half of all births are paid for by Medicaid.
Use a cost calculator to help determine your budget for everything beyond delivery—diapers, clothes, food, etc.
Start tracking your budget with an online tool like Mint.com, which links up with your bank accounts, credit card accounts, loan accounts, and other institutions to help you manage your finances. You can also use a guide, like this Nine-Month Plan from Parents.com to take a step-by-step approach to managing your finances.
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