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Pregnancy Health Coverage - How Much of My Pregnancy Costs Will My Insurance Cover?

Insurance Coverage Depends on Where You Live, What Kind of Coverage You Have and the Birth Itself

By Maureen Salamon

Updated December 15, 2009

(LifeWire) - Question: How much do medical expenses for a normal pregnancy typically cost, and how much of that will my insurance cover?

Answer: These questions don't have simple answers, unfortunately. Much depends on where you live, where you receive prenatal care and give birth, and the health insurance you have.

Childbirth is the number one reason for hospitalization in the United States, with postpartum mothers and newborn infants making up about one of every four patients, according to the Kaiser Family Foundation. Women of childbearing age make up more than a quarter of all uninsured Americans, and Medicaid -- a federally funded program that pays for health care for those with low incomes -- covers more than 40% of about 4 million annual American births.

Pregnancy Costs Are Variable

The average cost of a normal pregnancy and birth is about $7,600, according to a 2007 report from the Department of Health and Human Services. But that number varies, depending on location. Because of higher living costs in California, for example, giving birth there is more expensive than the same care in Arizona or Ohio. As a general rule, healthcare costs on both coasts are higher than in the center of the United States.

Prenatal and birth costs (a nine-month pregnancy typically involves at least a dozen obstetrical checkups) are better discussed as ranges. Because normal pregnancies can result in delivery by cesarean section, a more expensive procedure that accounts for about one-third of all U.S. births, the typical pregnancy costs between $6,000 and $12,000.

These costs have risen dramatically. In the late 1980s, the average cost for a hospital birth was about $4,000; by the late 1990s, it had risen to $5,500, according to the Kaiser Family Foundation.

For six in 10 women, insurance will pay some of the cost. How much is largely dependent on the insurer. Although some plans don't pay any maternity costs, federal law requires companies with more than 15 employees to supply coverage that includes pregnancy-related medical expenses.

The Nuts and Bolts of Pregnancy Costs

So-called "traditional" insurance plans offered by employers typically share the costs of medical care with employees, who often pay premiums. Employees also pay an annual deductible (the amount that must be paid before insurance coverage kicks in), a percentage of the total medical costs (co-insurance), and co-pays (a per-visit cost).

To use doctors and hospitals pre-approved by the insurance company (in-network), traditional plans usually require an annual deductible of $250 or $500. Patients also pay 10% of hospital costs, 15% of imaging (for ultrasounds) and anesthesia costs, as well as a $20 co-pay per doctor's visit. The highest total amount a patient may pay (an out-of-pocket maximum) is typically $4,000.

To use doctors and hospitals not on the company's approved list (out of network), patients' costs are usually much higher. Deductibles run from $300 to $600, and co-pays are $100. Patients are also typically charged 30% of hospital, imaging and anesthesia costs, and the annual out-of-pocket maximum can be $6,000.

To find out what your plan covers, consult the booklet issued by your insurance company that details all procedures, medications, doctors and hospitals it covers. If you've misplaced yours, call the toll-free number on the back of your insurance card and request another one.

What Will Your Bill Look Like?

If your insurance company has reviewed costs and paid its share, your bill may include only your final cost. But many hospitals itemize procedures and list the cost for each.

These procedures include delivery; newborn care costs; anesthesia and other medication costs; circumcision costs, if performed; and room costs, which may not be completely covered if you were in a private room.

Sources:

"Childbirth Services Estimated Average Charges." spectrum-health.org. 2008. Spectrum Health. 8 Jan. 2009 <http://spectrum-health.org/cs/Satellite?c=eHA_Content_C&cid=116>.  



"Health Insurance Overview." marchofdimes.com. 2009. March of Dimes. 8 Jan. 2009 <http://www.marchofdimes.com/peristats/tlanding.aspx?reg=99&top>.



"Kaiser Daily Women's Health Policy." kaisernetwork.org. 23 Oct. 2007. The Henry J. Kaiser Family Foundation. 8 Jan. 2009 <http://www.kaisernetwork.org/Daily_Reports/rep_index.cfm?DR_I>.



"Maternity Care and Consumer-Driven Health Plans." kff.org. June 2007. The Henry J. Kaiser Family Foundation. 9 Jan. 2009 <http://www.kff.org/womenshealth/upload/7836.pdf>.    


LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Maureen Salamon is a New Jersey-based freelance writer whose work has appeared in a variety of online and print publications.

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