Does Insurance Cover Birth and What You Need to Know

Insurance coverage for birth can be a complex and overwhelming topic, but understanding the basics can help you prepare for this life-changing event.

Some types of insurance plans cover birth, including employer-sponsored plans, individual plans, and Medicaid.

If you have a plan through your employer, it's likely to cover a significant portion of birth-related expenses, but the specifics depend on your plan's details and your state's laws.

A typical hospital stay for a vaginal delivery can cost upwards of $20,000, so having insurance coverage is crucial to avoid financial burdens.

Health insurers are required to cover maternity care and childbirth, one of the 10 essential health benefits required by the Affordable Care Act. Most plans have to give you coverage for at least these health situations.

You can get health insurance for your pregnancy from an insurance company rather than through the marketplace. However, the monthly costs for a plan may be high, so make sure the policy doesn't exclude pregnancy.

In some plans, like short-term health insurance plans, pregnancy is usually not covered.

If you already have health insurance coverage, here's what you need to know about having a baby.

If you have Marketplace coverage, it's best not to report your pregnancy to the Marketplace. This is because reporting your pregnancy may make you eligible for free or low-cost coverage through Medicaid or CHIP, and you won't be able to keep your current Marketplace plan.

However, if you do keep your Marketplace coverage, you'll need to update your application after giving birth to add your baby to the plan or enroll them in coverage through Medicaid or CHIP if they qualify.

Health insurers are required to cover maternity care and childbirth, which is one of the 10 essential health benefits required by the Affordable Care Act.

Most insurance plans require pregnant women to pay for a portion of their costs for labor and delivery. Your newborn may also start receiving their own medical bills from the moment they are born.

Here's a summary of what you can expect:

Maryland is the most expensive state for both vaginal deliveries and C-sections, with costs varying significantly from other states.

The cost for a vaginal delivery can range by more than $30,000 between states, making it essential to consider the costs when choosing a place to give birth.

Oklahoma has the cheapest cost for vaginal deliveries, making it a more affordable option for expectant mothers.

Vermont has the lowest price for C-sections, which is a significant difference from Maryland, the most expensive state for this type of delivery.

If you recently gave birth, it's essential to apply for health care services within 60 days to cover you, your baby, and any other household members.

Losing Medicaid or CHIP coverage after giving birth qualifies you for a Special Enrollment Period, allowing you to apply for Marketplace coverage.

You can report your baby's birth to the Marketplace by updating your application, which may change your coverage options and potential savings.

To report a life change, log into your account and select "Report a Life Change."

If you're unhealthy, you know how hard it can be to take care of yourself, let alone a new baby. Health coverage makes it easier to get the medical check-ups and screening tests to help keep both you and your baby healthy during pregnancy.

You might be able to enroll in a Marketplace health plan right now if you qualify for a Special Enrollment Period. Being pregnant doesn't qualify you for a Special Enrollment Period, but the birth of a child does.

Create an account now to apply for Marketplace coverage through the Open Enrollment Period. If you don't qualify for a Special Enrollment Period right now, you'll be eligible to apply within 60 days of your child's birth.

You can also enroll in coverage for the next plan year during the next Open Enrollment Period. If eligible for Medicaid or CHIP, your coverage can begin at any time.

If you recently gave birth, it's essential to have access to health care services for both new parents and baby. Make sure you apply for Marketplace coverage within 60 days after your baby's birth.

You can apply for Marketplace coverage if you had Medicaid or CHIP coverage that ended after you gave birth, or if your state told you it'll end soon. Losing other coverage qualifies you for a Special Enrollment Period.

If you're found ineligible for Medicaid or CHIP by the state agency, you can select that option when you fill out your application.

Here are the steps to follow:

If you're pregnant and uninsured, Medicaid is a great option for covering childbirth costs. Many states make it easier for pregnant women to enroll in Medicaid or a state-sponsored health insurance program.

Medicaid has the best coverage for childbirth when you're uninsured. These programs often mean your health care will be free or low-cost.

In some states, like California, pregnant women can qualify for Medicaid with a higher income than they would for regular Medicaid. For example, in California, a pregnant single woman with no other children can get Medicaid with an income of about $32,000 per year.

If you have Medicaid or CHIP, you'll be covered for at least 60 days after giving birth, depending on your state. This is a great benefit for new mothers who need ongoing care after childbirth.

If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage and will remain eligible for at least a year. This means your baby will have access to healthcare without any additional cost to you.

The cost of having a baby can be a daunting topic. The average cost of a vaginal birth is $13,024, including facility fees and doctor fees.

Having a C-section is significantly more expensive, costing an average of $22,646. This includes predelivery and postdelivery expenses like surgery preparation and recovery.

Your health insurance plan plays a big role in determining how much you'll pay for labor and delivery. The cost can depend on your plan's benefits, deductible, copayment amounts, coinsurance, and out-of-pocket maximum.

You'll also pay less if you choose an in-network doctor. Some health insurance plans don't cover out-of-network doctors or hospitals at all.

If you're considering alternative delivery methods, costs will generally be lower. You could use a midwife for maternity care, deliver at a birthing center, or even have your baby at home.

Here's a breakdown of average costs for vaginal deliveries and C-sections in the US:

Note that these prices are before insurance coverage and can vary depending on your individual circumstances.

If you don't have insurance, you may be able to negotiate prices with the doctor and hospital. However, be aware that without insurance, your expenses for a complicated delivery or a seriously ill newborn could reach into the high tens, or even hundreds, of thousands of dollars.

If you're expecting a baby, you've got options beyond the marketplace for health insurance.

You can get health insurance for your pregnancy from an insurance company, which may be more expensive than a marketplace plan but still more affordable than paying full price for delivery.

Some plans, like short-term health insurance plans, usually don't cover pregnancy, so make sure to check the policy carefully.

Pregnancy coverage might be excluded from certain plans, so it's essential to review the policy details before signing up.

The cost of childbirth varies greatly depending on the insurance plan's level of coverage, ranging from $460 to $8,224.

Most health insurance plans cover maternity care and childbirth, but the cost to you will depend on your plan's benefits, including your deductible, copayment amounts, coinsurance, and out-of-pocket maximum.

You can choose an in-network doctor to pay the lowest amounts, but some plans don't cover out-of-network doctors or hospitals at all.

Alternative options like midwife care, birthing centers, or home births can be more cost-effective, but your choices will be different than they would be in a hospital.

Here are the typical costs during childbirth, based on a sample insurance plan:

Some health insurance plans, like short-term health insurance plans, usually don't cover pregnancy, so make sure to check your policy before buying.

The Aetna Maternity Program is a valuable resource for expectant mothers. It provides personalized attention and resources throughout pregnancy, including educational materials on prenatal care, labor, and delivery, as well as access to specially trained nurses for high-risk mothers-to-be.

You can get educational materials in both English and Spanish, which is helpful for non-native speakers. These materials cover important topics such as prenatal care, labor and delivery, and newborn care.

A pregnancy survey is also part of the program, which helps determine if there are any risks for complications during pregnancy. This survey is a crucial step in ensuring that you receive the best possible care.

The program also includes a preterm labor program to support high-risk women, as well as one-on-one counseling to help pregnant women quit smoking.

Here's a summary of the Aetna Maternity Program's benefits:

This program is a great example of how healthcare plans can provide valuable support and resources to expectant mothers.

Questions to ask your health insurance provider can make a huge difference in understanding your coverage and avoiding unexpected medical bills. The costs for pregnancy and childbirth are often capped at the individual level, with an out-of-pocket maximum of up to $9,200 for marketplace plans in 2025.

You should ask your provider how your insurance plan handles the cost-sharing for your newborn. Some plans consider the baby's medical bills as part of the mother's costs until they're both released from the hospital, while others count their bills toward their own deductible and cost-sharing from the date of birth.

Understanding how your insurance plan's individual and family benefits work can help you prepare for medical bills. Your household spending may hit the family out-of-pocket maximum, which can't be higher than $18,400, if expensive healthcare is needed for other family members.

Adding your new baby to your plan can push you into a family plan, which will likely make your health insurance more expensive. You should ask your provider when your baby's medical bills will start to count toward their own deductible, copays, and coinsurance.