The Rising Cost of Pregnancy: What Can Parents Do About It?
This story is part of Priced Out, CNET’s coverage of how real people are coping with the high cost of living in America.
On a warm day last spring, Teja Smith, 31, went to Cedars Sinai Hospital in Los Angeles to discuss her birth plan. Instead, at just over 36 weeks pregnant, she found out she had preeclampsia, a serious high blood pressure condition that can occur during pregnancy and needed immediate treatment. Three days and an unplanned cesarean later, Smith walked out with her newborn son and a $42,180 medical bill.
Although her insurance covered $40,000 of that bill, Smith was left with the balance. “I was even charged with skin contact with my son and cutting my umbilical cord,” she said.
Teja Smith and family.
Smith’s story is not unusual. The cost of childbirth in the United States is higher than in any other country. For parents with insurance, the average outlay for a traditional birth is $2,854, while a cesarean like Smith’s costs an average of $3,214, according to the Kaiser Family Foundation.
If you don’t have insurance, the cost can quickly add up to tens of thousands of dollars. Although resources are available to reduce pregnancy-related costs, there are still gaps in accessibility and wide disparities in the cost of medical care for uninsured or underinsured individuals.
Low-income pregnant women, particularly those from Black and Hispanic families, are less likely to have health insurance, and these families spend an average of between 19% and 30% of their annual income on pregnancy- and childbirth-related medical expenses. And that doesn’t include the hidden off-work costs that start in the family planning phase or the post-delivery expenses.
“My number one piece of advice is never to go into pregnancy uninsured, even if it’s Medicaid or something the state provides,” Smith said.
Pregnancy bills are steep for everyone
Shilpa Nandwani, 30, a teacher in Austin, Texas, always knew she wanted children. After getting married, Nandwani and her partner decided to try in vitro fertilization (IVF) in December 2021.
Shilpa Nandwani and her partner.
Nandwani’s insurance provided 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, genetic testing of the embryo, and frozen embryo transfer for both of them. Without Progyny’s help, her bill would have been $32,000.
Fertility treatments like IVF and intrauterine insemination are becoming more common in the US — about 33% of Americans have sought out fertility treatments or know someone who has, according to a Pew Research Center study. But these treatments come with huge costs for those who perform them.
“The road to parenthood isn’t always as easy as what we’ve heard from movies and storybooks,” said Janet Choi, a reproductive endocrinologist and medical director of the CCRM Fertility Clinic in New York. Choi noted that a drug-based IVF round can cost more than $25,000 and often takes two to three cycles to be successful.
dr Janet Choi: “The road to parenthood isn’t always as easy as what we’ve heard from movies and storybooks.”
According to Choi, an employer-sponsored fertility program is vital for those who must walk this path. “Not only can it help offset the financial burden of fertility treatments, but it can also support the mental and emotional toll of the process,” she said.
Conception costs can burden expectant parents with high medical bills, even before pregnancy begins. For many, the first issues after learning they are pregnant begin during the prenatal period. Regular doctor appointments for exams, blood work, ultrasounds, and other tests run from $100 to $200 per appointment (most pregnant women attend 12 appointments during their pregnancy). Genetic carrier 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 to out-of-pocket expenses.
Then there are prenatal vitamins, maternity clothes, and pregnancy-safe skincare and makeup, which easily add up. For example, Nandwani pays $50 for a two-month supply of prenatal vitamins — she estimates she will have spent $750 on supplements during her pregnancy and postpartum alone.
Childbirth is generally the most expensive of all, and your insurance may not cover these costs if you choose non-traditional childbirth methods, which have become increasingly popular over the past five years.
Nandwani and her partner choose to give birth outside of a hospital. “We went down the route of getting a doula and a midwife because, as a queer couple, I also didn’t want people to question our parenting titles and relationship with our baby,” she said. The couple pays $2,000 for their doula and $5,000 for midwifery services.
Health insurance can reduce pregnancy costs
High medical 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.
With half of all pregnancies in the country being unplanned, households without insurance are struggling to get medical care. Although employer-funded health plans and the public health insurance marketplace may offer low-cost options, the small open enrollment window, which typically falls between November 1 and January 15, could prevent expectant parents from enrolling. To receive coverage outside of an open policy period, a “qualifying life event” is required, e.g. B. starting a new job, getting married or losing your existing insurance coverage. Childbirth is considered a “qualifying life event” but pregnancy is not. Depending on the timing, some expectant parents may not be able to enroll for coverage at all, while others may be able to enroll towards the end of their pregnancy.
If health insurance is not an option, Medicaid can provide coverage. Lower-income pregnant women who meet state income requirements may be eligible for reduced or even free Medicaid coverage, but there are still gaps in the system that prevent more comprehensive maternal and child health care. And although the majority of states have introduced extended 12-month coverage for women after childbirth, some states end Medicaid benefits 60 days after childbirth.
Further expanding Medicaid benefits to offer affordable coverage to more pregnant women could not only ease the financial burden on new parents but also help lower the maternal mortality rate, which Georgetown says is higher in the US than in any other advanced country Institute for Health Policy of the University.
Additional resources and support to help with pregnancy expenses
Whether you have insurance or not, there are options that can help you reduce your out-of-pocket pregnancy costs.
Nandwani has taken on temporary 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 high-risk pregnancies. Working more than 40 hours a week during pregnancy has been linked to serious health risks, including miscarriage and preeclampsia.
You may also be able to negotiate part of your medical expenses if you can demonstrate financial need. “Some hospitals allow you to file financial records if you can’t pay for certain things or agree to a payment plan,” Smith said.
If you plan to pay for all or part of your prenatal care out of your own pocket, let your doctor know. They may be able to offer cheaper treatment options, a discounted package price, or if they can’t lower prices, they may refer you to a cheaper clinic or doctor.
There are other programs and resources for uninsured parents-to-be who don’t qualify for Medicaid. 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 affordable pregnancy care services. The US Department of Health and Human Services also has a list of resources designed to help pregnant women access free or lower-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 women or new parents can help you better prepare for financial expectations while offering solutions that others have implemented. The Children’s Hospital of Pennsylvania has a collection of different groups for expectant parents to explore.
“Seek support in any way you can,” Nandwani said. “Part of the support is talking to your partner or family about finances and understanding the potential costs.”