Although the Affordable Care Act requires employer-sponsored insurance plans to cover maternity care, birthing people may pay thousands of dollars out-of-pocket, which may threaten access to high-quality care, according to a new report by Health Care Cost Institute (HCCI). Using HCCI’s commercial claims database, which includes claims for over one-third of the population with employer-sponsored insurance, they found that birthing people in the U.S. paid nearly $2,000 out-of-pocket, on average, when they had a baby in 2020. These out-of-pocket costs include deductibles, coinsurance, and copayments.
The high out-of-pocket cost associated with childbirth, which accounts for delivery expenses only, not including prenatal or postpartum expenses or other costs such as newborn care, can pose a major burden for families at a time when they are facing a range of decisions, adjustments, and expenses. Overall, 87% of birthing people in HCCI’s data had some out-of-pocket spending for their delivery. Exactly how much they paid varied based on where they live and the kind of delivery (i.e., c-section vs. vaginal delivery). Differences in out-of-pocket spending only partially reflect differences in overall costs; differences also are affected by factors like benefit design and whether a birthing person has reached their out-of-pocket maximum.
The brief also examines the average cost for childbirth, nationally as well as in each state and a range of local metro areas, overall and separately for c-sections and vaginal births.