Having a Baby?

Having A Baby

Hello folks! As many of you may know, my wife and I are expecting our second child in the beginning of April. If you too are expecting a child or already have kids, you know there is a lot to think through and prepare; especially when it comes to finances. And I thought who better to talk through it all than the good folks over at Amino. So I invited Hannah to stop by and give an overview on everything that can and will affect the cost of labor and delivery.

Having a baby?

Learn about the different factors that will affect your cost of delivery

By Hannah Levy

About the author: Hannah works in marketing at Amino, a healthcare transparency company with data on nearly every doctor in America and billions in healthcare spending. Amino delivers personalized results to help you easily estimate your costs and book appointments with doctors. Before Amino, Hannah led content strategy for Fastly and Practice Fusion, and consulted for healthcare and education startups at LaunchSquad.

 

Having a baby is a whirlwind experience—and an expensive one! From pregnancy 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.

What does the Affordable Care Act cover?

The Affordable Care Act (ACA), also known as Obamacare, mandates coverage for prenatal and postpartum care. This means that your insurance plan should cover the majority of costs for prenatal appointments as well as 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:

  • Well woman visit
  • Routine anemia screenings
  • Folic acid supplements
  • Gestational diabetes screening
  • Hepatitis B screening
  • Rh incompatibility screening
  • Syphilis screening
  • Urinary tract infection screening
  • Breastfeeding support and counseling
  • Breast pumps

The postpartum care services for newborns include:

  • Behavioral assessments and developmental screenings
  • Blood pressure screening
  • Gonorrhea preventive medication
  • Hearing screen
  • Height, weight, and body mass index
  • Hematocrit or hemoglobin screening
  • Hemoglobinopathies or sickle cell screening
  • Immunization vaccines

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.

Also 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.”

How your health insurance affects your cost of having a baby

Having a BabyYour insurance plan matters

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.”

Make sure your doctor and hospital are in-network

As you decide which doctor you want to deliver your baby and which hospital you want to go to, you’ll need to further 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 takes your insurance, in case something happens during your pregnancy—out-of-network emergency room bills can be extremely pricey.

Beyond insurance, other factors that affect your delivery costs

Having a BabyWhile 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.

A doctor’s experience treating similar patients

When you’re bringing a life into the world, it’s important to trust the people helping you. 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. So if you’re having twins, have gestational diabetes, preeclampsia, or another type of complication during your pregnancy, finding an OB/GYN who has experience treating people in your situation is important.

But experience is very difficult to measure. That’s where Amino comes in. Amino is 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), the company has 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.

Vaginal delivery vs. C-section

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.
  • Go to Amino’s find a doctor service and search for “pregnancyto 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 also help you compare hospitals to determine their safety score.

What happens during your delivery

Having a BabyYou 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 anaesthesiologist (as stated above, anaesthesiologists 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 CM during labor are twice as likely to have a C-section.
  • Other health problems—according to the Mayo Foundation for Medical Education and Research, some common and costly delivery complications include premature rupture of the amniotic sac, abnormal presentation, dangerous umbilical cord positioning, difficulty breathing, amniotic fluid embolisms, irregular blood pressure, postpartum hemorrhage, bleeding in the brain, fluid accumulation in the brain, neurological problems, intestinal problems, jaundice, and anemia. These conditions might require certain emergency procedures that would affect your total costs for delivery.
  • Random charges—you might see some outrageous charges on your bill, for example, your hospital charging for facilitating skin-to-skin contact with your baby.

Your health and the health of your baby

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. And 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.

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.

Questions to ask, ways to reduce your hospital bill, and managing your budget

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.
  • Research hospitals. Do your research and compare prices at different hospitals.
  • Look for hospital bill errors. After you give birth, check your hospital bill for errors by using a service like Remedy or Copatient. 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 Account (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 Personal Capital, 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.

 

Thanks again for stopping by and sharing all this helpful information and resources, Hannah!

 

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32 Comments on "Having a Baby?"

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Mrs. Picky Pincher
Guest

That’s kind of crappy that ultrasounds don’t have decent coverage; that’s a pretty critical part of prenatal care.

Mr. Picky Pincher and I don’t have Little Pinchers yet, but we do plan on having kiddos within the next two years. We’ll contribute to an FSA to prep as well as bulk up our cash savings. I do plan on scrutinizing every little charge because both hospitals and insurers mess up plenty of things!

Vicki@MakeSmarterDecisions
Guest
Great post Hannah! I think Amino is going to play a huge role as people start to realize more and more that they need to “shop” for healthcare. No babies for us – but plenty of other health care issues as we continue to age. We are also having to look into the whole “in and out” of network doctors – and we’ve never even considered that before (as we travel and consider spending time in two different states!) We were taught to just “follow the doctor’s orders” – but now is the time as Mrs. Picky Pincher above says – to scrutinize every charge. I’m doing that as I get ready to get new glasses. The last ones I bought had a whole page… Read more »
Full Time Finance
Guest

Great post, very educational and thorough. I might add one ancillary item. Since your likely to hit your deductible in the pregnancy year anyway, schedule any other tests and procedures you’ve been delaying for the same year to save money. When my wife had our last child I went in for a procedure I’ve been delaying and she saw a specialist for an unrelated question.

Hannah Levy
Guest

That’s great advice! Thanks for reading and for the comment.

Wes @ TPOHappiness
Guest

Thanks for another great post but there is one thing I would add expense wise and that is a birthing class (though not every reader would attend one). We used the Bradley Method and it was very enlightening!

Roadrunner
Guest

First of all I wish you guys a lot of happiness! Waiting for the second one must be really exciting!
Wow, reading these numbers makes me happy that I live in Europe. Of course we do pay insurance every month, but when our daughter was born we didn’t have to pay anything extra. After the delivery skilled nurses came over to our place every day for a week in order to help around the baby. Most of that was also covered by the insurance.
Of course there are many things that are better in the US, especially when it comes to saving and investing. But in terms of healthcare, I’m not envy at you guys…

Taylor
Guest

This is a great resource for me to use for our next child!
I just finished paying all of the bills from our first little one that was born in September. We have a HDHP and payed almost $5k out of pocket. The total cost was around $28k for mom and our daughter!!

Lars-Christian
Guest

My SO and I are expecting, our first, and posts like these make me truly appreciate living in a country with free (tax financed) health care. There’s enough financial aspects of having a baby, from the price of strollers, trying to find out what you need to buy, and, eventually, the cost of day care and what not. Adding the price of delivery on top of that just seems like it’s too much!

Great post for those who are expecting in the States, though, and a nice glimpse into the differences for those of us who live elsewhere.

Cody
Guest
Cody
Congratulations, Swan family! You guys are in for a treat watching your son interact with the new baby. Watching our oldest (almost 2 and 1/2 when our second was born) interact during the pregnancy and in welcoming the new baby into our home melted us into putty. Enjoy! Thank you for the informative post. There are lots of tidbits of wisdom here. We were on the hook for $1,800 out-of-pocket for our first delivery and $3,200 for our second. Interestingly, nothing changed with our insurance and thankfully, both deliveries were as smooth as can be. The first was in 2013 and the second in 2016. We were fortunate to be able to finance the amounts for 18 months each at 0% interest.
Alexis @FITnancials
Guest

I’ve never been pregnant, but have been a nanny and babysitter for many families and they would often tell me how expensive it was to have their baby. I couldn’t even believe it was in the $5000 range!

Mrs. BITA
Guest
This is a fantastic post. Here are a few more things to consider: 1. If you are tagged with that most glamorous of titles ‘AMA’ or of ‘Advanced Maternal Age’ (super sexy no?) be prepared for higher costs – you will have more ultrasounds than usual, you may need an amniocentesis, you may need weekly fetal non-stress tests towards the end of your last trimester. 2. There are plenty of pretty cool new genetic tests now available based on blood draws very early in the first trimester. We got ours done (and found out gender at 11 weeks!) and insurance paid for it, but I’ve had friends on different plans discover that this was not covered by their insurance. An aside: our total bill from… Read more »
Femme Frugality
Guest

I was very fortunate and had everything covered during pregnancy. Do companies that self insure have to follow ACA guidelines versus those that use commercial insurance?

Hannah Levy
Guest

Hi Femme Frugality, great question. Under Section 2713 of the ACA, private health plans must provide coverage for a range of preventive services — including prenatal care and care for newborns outlined in our article (the bullet point section) — and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on patients receiving these services. These requirements apply to all private plans – including individual, small group, large group, and self-insured plans in which employers contract administrative services to a third party payer – with the exception of those plans that maintain “grandfathered” status. You can check out further information here: https://www.healthinsurance.org/faqs/do-all-health-insurance-plans-cover-maternity/

Mustard Seed Money
Guest

This is really great information that I wish we had seen two years when my wife was pregnant. She did a ton of research to make sure that she found doctors and hospitals that wouldn’t push a c-section to “get it over with.” My wife was really lucky in the practice that she found and she had a natural birth that took a little over 5 hours from the time that we entered the hospital. But the amount of information at times is so overwhelming. We will definitely be checking out Amino if we are lucky enough to have a 2nd child.

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[…] family is expecting this spring! J.W. had a great guest post from Hannah at Amino Health on the factors that will affect the cost of delivery. Not having a baby – but worried about rising health care costs? Check out Amino and start […]

Harmony@CreatingMyKaleidoscope
Guest
Harmony@CreatingMyKaleidoscope
Thanks for this informative post! I have a lot on my mind lately, including the costs involved with having twins. My previous deliveries were all very uncomplicated. Now, I’m facing higher chances of premature birth, c-section, and NICU stays. There are co-pays involved with two babies, instead of just one. And, the increased care has already started – I have to go for ultrasounds every three weeks! Fortunately, we planned ahead with health insurance. We have a high deductible plan and an HSA with a healthy balance. We will pay for all expenses up to a certain amount (with the HSA), then everything will be covered. I still worry about whether we’re not considering something important, but don’t want to put myself through too much… Read more »
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