With the often confusing nature of modern health insurance in the US, many would-be parents question whether they can afford to bring a new child into the world.
So, does insurance cover childbirth? The good news is that, in most cases, the answer is yes. The Affordable Care Act (ACA) requires health insurers to cover essential health benefits, including pregnancy and childbirth. To meet federal standards, these plans must include coverage for prenatal and childbirth services even if the mother was not insured at the time of conception. |
However, some insurers may have exclusions or limits on what their maternity and childbirth policies cover. Here, we’ll explain how childbirth coverage works in the United States, along with some regulations governing maternity insurance and the potential economic impacts on families.
Typical Childbirth Coverage in Health Insurance
Medical insurance plans must offer maternity coverage. The ACA mandates that insurers cover prenatal care, labor and delivery, and postpartum and newborn care. Most policies also offer breastfeeding support and equipment, if necessary.
Typical areas of coverage include the following:
Prenatal care, including checkups and screenings
Hospitalization during labor and delivery, including emergency procedures
Newborn checkups and other postnatal care
Medicaid and the Children’s Health Insurance Program (CHIP) provide coverage for mothers and their children at any point during pregnancy, depending on the eligibility requirements in each state. Eligibility criteria may include factors like household income, length of residence, family size, and immigration status.
The depth of coverage may vary between ACA and employer-provided insurance. Some insurers may require a waiting period before coverage takes effect. Policies may also exclude certain benefits, such as voluntary C-sections, in-vitro fertilization (IVF), and private hospital rooms.
Some insurance plans have higher copayments, deductibles, and out-of-pocket maximums. Thus, the specific plan that parents choose can significantly impact their budget. As with many other health concerns, pregnant patients may be required to select physicians from within an approved network of providers.
Marketplace vs. Employer-Provided Insurance
Does insurance cover childbirth? Yes, but there may be significant differences in childbirth coverage, depending on whether the parent is insured by a federally mandated plan or one offered by their employer.
Plans deriving from the ACA (those purchased through the Health Insurance Marketplace) must cover childbirth as an essential health benefit. The level of coverage may differ from state to state, as may deductibles and copayments. Some families may qualify for subsidies or price reductions, which can make coverage more affordable.
Employer-backed insurance plans may not have the same childbirth coverage requirements as marketplace plans do. However, employers generally offer plans that meet federal minimum standards.
Additionally, it’s in many companies’ best interests to offer competitive insurance plans as part of their benefits packages. Employees of these companies have access to more favorable coverage terms and lower premiums than those who choose marketplace plans.
Often, deductibles and out-of-pocket expenses are lower in employer-sponsored childbirth insurance plans. Some employers even cover most or all of their employees’ premiums, which can make a big difference in their paychecks. These plans may also offer unique incentives, such as telehealth options, that aren’t required in marketplace plans.
However, the breadth of coverage in an employer plan is contingent on the business owner’s generosity. Some may not cover alternative pregnancy services, lactation support, or specific pediatric treatments at their discretion. Most require strict adherence to the provider network.
Smaller businesses with employee rosters of 50 or less aren’t bound by ACA requirements and don’t have to offer any medical coverage at all, including for childbirth. However, many of these companies do provide insurance in order to retain talent and recruit new employees.
Childbirth Expenses With and Without Insurance
The cost of having a child differs from state to state. According to Forbes, the average cost of childbirth is $18,865. Vaginal delivery is always less expensive than Cesarean procedures, and certain prenatal care services may be covered. The cost may also go up or down according to medication, hospital charges, and other factors.
In most cases, mothers with effective medical insurance will pay much less than those without coverage. The Peterson-KFF Health System Tracker data reported in the Forbes article reveals that the average out-of-pocket costs for insured parents totaled $2,854, which is about 15% of the total childbirth cost.
Without insurance, the patient must pay for all childbirth-related expenses. It’s safe to say most everyday families would struggle to pay $18,865 — and that number doesn’t factor in unexpected price hikes or unforeseen medical treatments.
What to Do if Your Insurance Doesn’t Cover All Childbirth Expenses
Before you get surprised with unexpected charges from your health provider in childbirth, take the time to review your policy carefully to determine what it does and doesn’t cover. You can also call your insurer to ask about exclusions or coverage gaps that may affect your care.
If your bills have become too much to handle, ask your healthcare provider about installment programs or other financing options that can help you fit childbirth expenses into your budget. Low-income families can look into Medicaid or other state-sponsored health insurance programs that offer support for those who are struggling financially.
You may also look into supplementary insurance programs to cover conditions and therapies not included in your current plan. These maternity insurance plans may cover some things that standard plans often omit, like birthing centers, home births, maternity health classes, and extended hospital stays.
Learn the Facts About Childbirth Insurance
Whether you have employer-sponsored or marketplace medical insurance, your insurance provider should cover the most common costs of pregnancy and delivery.
However, policies differ in the breadth and depth of covered items and procedures. It’s worth taking a close look at what provisions are most important to you and your family. If you’re planning on expanding your household, consider your insurance options with an eye toward the future.
