Bearing the Financial Cost of Pregnancy: What Expectant Parents Should Expect

This story is part Fixed priceCNET’s coverage of how real people are coping with the high cost of living in the United States.

On a hot day last spring, 31-year-old Teja Smith checked into Cedars-Sinai Hospital in Los Angeles to review her birth plan. Instead, at just over 36 weeks pregnant, she was told she had preeclampsia, a serious high blood pressure disorder that can occur during pregnancy and needed to be induced immediately. Three days and an unplanned C-section later, Smith walked out with her newborn son and a medical bill of $42,180.

Although her insurance covered $40,000 of that bill, Smith was left with the remaining balance. “I was even charged for skin-to-skin contact with my son and the cutting of my umbilical cord,” she said.

Smith’s story is not uncommon. The cost of childbirth in the United States is higher than in any other country. For insured parents, the average out-of-pocket for a traditional birth is $2,854, while a C-section, like Smith’s, costs an average of $3,214, according to the Kaiser Family Foundation.

If you don’t have insurance, the costs can quickly run into the tens of thousands of dollars. While there are resources available to help reduce pregnancy-related expenses, there are still gaps in accessibility and huge disparities in medical care costs for the uninsured or underinsured.

Low-income pregnant women, from black and Latino families in particular, are less likely to have health insurance, and these families spend on average between 19% and 30% of their annual income on pregnancy-related medical costs and at childbirth. And that doesn’t include hidden costs outside of labor that begin at the family planning stage, or expenses that continue after childbirth.

“My biggest piece of advice is to never fall into a pregnancy without insurance, even if it’s Medicaid or something that’s provided by the state,” Smith said.

Pregnancy bills are high for everyone

Shilpa Nandwani, 30, a teacher in Austin, Texas, always knew she wanted kids. After their wedding, in December 2021, Nandwani and her partner both decided to try in vitro fertilization, or IVF.

Nandwani’s insurance offered access to Progyny, an employer-sponsored fertility and family building benefit. She and her partner went through the egg retrieval process, which cost a total of $8,000 for everything, including sperm donation, embryo genetic testing and frozen embryo transfer for both. Without Progyny’s help, their bill would have been $32,000.

Fertility treatments such as IVF and intrauterine insemination are becoming more common in the United States – around 33% of Americans have sought fertility treatment or know someone who has, according to a study by the Pew Research Center. But these treatments come at a huge cost to those who undertake them.

“The road to parenthood isn’t always as smooth as what we’ve heard in movies and storybooks,” said Janet Choi, reproductive endocrinologist and medical director at CCRM Fertility Clinic in New York. . Choi noted that an IVF cycle with medication can cost upwards of $25,000 and often takes two to three cycles to be successful.

An employer-sponsored fertility benefits program is essential for those who need to go down this route, according to Choi. “It can not only help offset the financial burden of fertility treatments, but can also take the mental and emotional strain of the process,” she said.

Conception costs can leave expectant parents with high medical bills even before pregnancy begins. For many, the first expenses begin after discovering that they are pregnant, during the prenatal term. Regular doctor’s appointments for exams, blood tests, ultrasounds, and other tests cost between $100 and $200 per appointment (most pregnant women attend 12 appointments during their pregnancy). Genetic testing, which may be required to detect certain congenital disorders, is not always covered by insurance and can add an additional $100 to $1,000 in out-of-pocket expenses.

Then there are prenatal vitamins, maternity clothes, and pregnancy-safe skincare and makeup, which all add up easily. For example, Nandwani pays $50 for a two-month supply of prenatal vitamins – she estimates she will have spent $750 on supplements alone throughout her pregnancy and postpartum.

Childbirth is usually the most expensive of all, and these costs may not be covered by your insurance if you opt for non-traditional birthing methods, which have become more popular over the past five years.

Nandwani and her partner choose to give birth outside of a hospital. “We decided to go with a doula and a midwife because as a queer couple, I also didn’t want people to question our titles as parents and our relationship with our baby,” he said. she stated. The couple will pay $2,000 for their doula and $5,000 for the services of a midwife.

Health care coverage can reduce pregnancy-related expenses

High doctor or hospital bills during pregnancy can lead to serious long-term consequences, including medical debt, bankruptcy, and in some cases, worsening health outcomes. According to a recent study published in the Journal of the American Medical Association, up to 24% of pregnant or recently pregnant women report having unmet health care needs, which can lead to adverse birth outcomes and other risks.

Since half of all pregnancies in the country are unplanned, households without insurance have to scramble to get medical care. Although employer-sponsored health plans and the public health insurance market may offer low-cost options, the small open enrollment window, which typically falls between November 1 and January 15, could prevent future parents from registering. Obtaining coverage outside of an open enrollment period requires a “qualifying life event” such as starting a new job, getting married, or losing your existing coverage. Childbirth is considered a “qualifying life event”, but pregnancy is not. Depending on the timing, some expectant parents may not be able to sign up for coverage at all, while others might be able to sign up towards the end of their pregnancy.

If health insurance is not an option, Medicaid may provide coverage. Low-income pregnant women who meet state income requirements may qualify for reduced or even free Medicaid coverage, but there are still gaps in the system that prevent broader maternal and child health care coverage. . And, although the majority of states have implemented extended 12-month coverage for postpartum women, in some states Medicaid benefits end 60 days after delivery.

A further expansion of Medicaid benefits to provide affordable coverage to more pregnant women could not only reduce the financial burden on new parents, but also help reduce maternal mortality rates, which are higher in the United States than in any other advanced country, according to the Georgetown. University Institute for Health Policy.

Additional resources and support to help cover pregnancy costs

Whether you are insured or not, there are options to help you reduce your pregnancy costs.

Nandwani has accepted contract work in addition to her full-time job, a financial solution that works well for her family. While this option may be pragmatic for some, it may not be recommended for those with high risk pregnancies. Working more than 40 hours a week during pregnancy has been linked to serious health risks, including miscarriages and preeclampsia.

You may also be able to negotiate some of your medical expenses if you can demonstrate financial need. “Some hospitals allow you to submit financial records if you are unable to pay for certain things or agree to a payment plan,” Smith said.

If you plan to pay for all or part of your pregnancy care out of pocket, let your health care provider know. They may be able to offer lower cost care options or a reduced flat rate, or if they are unable to lower prices, they may be able to refer you to a clinic or doctor more affordable.

For uninsured expectant parents who do not qualify for Medicaid, there are other programs and resources. The Special Supplemental Nutrition Program for Women, Infants and Children, or WIC; Children’s Health Insurance Program, also known as CHIP; and Planned Parenthood all offer low-cost pregnancy care services. The US Department of Health and Human Services also has a list of resources to help pregnant women access free or low-cost services.

Connecting with others in your community or across the country through Facebook groups and other online forums is a great way to share cost-cutting tips. Talking to other pregnant people or new parents can help you better prepare for financial expectations, while offering solutions that others have implemented. Children’s Hospital of Pennsylvania has a collection of different groups that expectant parents can explore.

“Find support in any way you can,” Nandwani said. “Part of the support is talking about finances with your partner or family and understanding the potential costs.”