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Altogether, your pregnancy costs will depend on these four different factors.
Pregnancy is a time of excitement and anticipation. One thing you don’t want to be anticipating is how much it will cost you out-of-pocket. By doing research ahead of time, you can make sure you are financially prepared when planning your family.
So, how much are overall pregnancy costs? Well, the short and frustrating answer is – it depends.
Factors to Consider When Estimating Your Pregnancy Costs:
1. Complexity of the Pregnancy and Delivery
The complexity of your pregnancy and delivery is hardly something you can predict or control. While your birth plan may be to deliver vaginally, circumstances outside of your control might make a C-section the safest option. A study by Truven found that cesarean births cost about 50% more than a vaginal birth, on average.
It’s important to have a thorough understanding of what your plan won’t cover. The Pregnancy Discrimination Act of 1978 and the Affordable Care Act have made it very rare for plans to not cover maternity and newborn care. However, one caveat is the case of dependent maternity care, which applies to pregnant women covered under their parent’s insurance. If you are still on your parent’s plan, be sure to check if it covers dependent maternity.
2. Network Types
Consider the plan network options available to you when planning a family. It will be easier to get health insurance once your baby is born. Although having a baby is a qualifying life event, pregnancy is not.
If you think you might become pregnant soon consider changing plans during the open enrollment period for your plan – it may help you save money on your overall pregnancy costs. Some network options include:
PPO (Preferred Provider Organizations) Plans are plans with higher monthly premiums in exchange for lower deductibles. They also include copays for routine office visits, prescriptions, etc.
HMO (Health Maintenance Organizations) Plans are plans with usually lower costs and often cover most costs associated with pregnancy, but in exchange your access is a little more limited. For example, you have to stay within your HMO network, and seeing a specialist will require you to consult your primary care physician (PCP) and get a referral.
HDHPs (High Deductible Health Plans) are just as the name suggests: plans with higher deductibles in exchange for lower monthly premiums. There are no copays, meaning the patient is charged the full amount for a doctor’s visit or prescription. These are often accompanied with a Health Savings Account, meaning you can use pre-tax dollars to pay for the higher cost of the doctor’s visits and prescriptions.
3. Your Chosen Hospital and OBGYN
Firstly, check to make sure the doctor and hospital you intend to deliver with are in-network. Don’t assume that just because the hospital is in-network that the doctor is too. Sometimes doctors are contracted with the hospital but not with the insurance company. Physicians can bill for services separately from the hospital and if they are not in-network then, depending on your plan, these pregnancy costs will be subject to higher out-of-pocket costs.
Secondly, understand that costs widely vary from hospital to hospital and doctor to doctor, making it nearly impossible to anticipate exactly what you will be charged. A study done by the University of California found that women in California could be charged anywhere from $3,296 to $37,227 for a routine vaginal delivery. For a C-section, the bills ranged from $8,312 to $71,000. And while these are the billed prices, discounted rates vary by insurance company, further muddying the waters of what exactly you can expect to pay.
4. Overlapping Plan Years
Most insurance plans run on a calendar year schedule, meaning your deductible, co-insurance and out-of-pocket reset back to $0. Why is this important? Well, let’s say you are due at the end of January. You will have received the majority of your pre-natal care in the previous plan year, meaning that everything you have paid out-of-pocket won’t apply to meeting your out-of-pocket costs for the delivery in January. Remember to check you plan year when researching your anticipated costs. A tip: consider conceiving around Valentine’s Day to keep costs limited to a single calendar year.
Pregnancy Costs You Should Expect
During the first and second trimester you’ll have monthly check-ups with your doctor to check your weight, blood pressure and urine sample. These are typically subject to co-pay for those on a PPO plan. If you are on a HDHP and haven’t met your deductible you will pay the full billed amount.
Routine Lab Work
During check-ups, doctors will draw blood to screen for birth defects, infections, your blood type and Rh status. Like the monthly checkups, what you pay will depend on your plan type.
Typically occurs between weeks 16 and 20 of pregnancy. This will determine the overall health of the baby and its position relative to the placenta. Earlier ultrasounds might occur to determine the viability of the pregnancy. Fetal ultrasounds cost $309 on average, according to the Healthcare Bluebook.
Cell-Free Fetal DNA Testing
This is a blood test done after 10 weeks of pregnancy to determine if the baby has a chromosomal anomaly. It’s not required for insurance plans to cover this test so check your plan to see if it’s covered.
Chorionic Villus Sampling
A placenta test that can detect chromosomal anomalies and genetic diseases like cystic fibroisis, Tay-Sachs disease and sick cell anemia. This is performed at 10 to 13 weeks of pregnancy. Most plans cover this, especially for women over 35. Double check with you plan to be sure.
This is usually conducted in the second trimester to test for gestational diabetes. This is usually covered but check with your plan to be sure.
Similar to chorionic villus sampling, this test will identify if there is a chromosomal issue or genetic diseases such as cystic fibrosis, sickle cell disease and Tay-Sachs disease. It occurs later in pregnancy, between weeks 15-20. It’s usually covered, especially in women over 35.
Expected Delivery Expenses You Should Expect
It’s difficult to pinpoint the exact cost of a delivery because of all the variables. All the medication needed, the epidural, anesthesiologist fees, the delivery room, and more will add up to the final billed amount.
Your best bet is to call the hospital where you plan to deliver and ask for an estimate of charges that will apply. Be sure to tell them who your insurer is so they can give you the discounted rate according to your provider.
Call your insurance provider to get a rundown on your covered versus uncovered services and your financial obligations. Call the hospital and doctor’s office for an estimate of billed charges.
If you’re pregnant or planning a family, it’s recommended that you save enough to meet your out-of-pocket limit and then add a little cushion in case you run across un-covered charges. Prepare the best you can but don’t get too hung up on the cost.
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