How Expensive Is It to Have a Hospital Birth?

Giving birth can be a costly affair in the United States. Let’s take a closer look at the expenses involved, from prenatal care to hospital stays.

Welcoming a new member to the family comes with a price tag, and it’s not just about the expenses of raising the child. The costs associated with prenatal care, delivery, and postpartum care can accumulate rapidly. Childbirth stands as one of the most expensive healthcare events for many American families during their childbearing years.

Various factors play a role in determining the total cost, as noted by Aleksandr M. Fuks, MD, Director of Obstetrics and Gynecology at NYC Health + Hospitals/Queens in New York. Let’s delve into the breakdown of the expenses involved in a hospital birth in the US and the factors influencing your final bill.

Estimating the Expenses of Childbirth

Determining the cost of giving birth in a hospital in the United States can be quite complex. Various types of births have different price tags, and factors such as the healthcare providers, hospital, location, and insurance coverage all contribute to the final bill. Calculating how much you will personally need to pay out of pocket adds another layer of complication.

Research conducted by the Kaiser Family Foundation (KFF) focused on the expenses associated with childbirth for individuals covered by employer-sponsored health insurance. This analysis encompassed costs for prenatal care, delivery, and postpartum care. In 2020, approximately 54% of Americans had health insurance through their employers, as reported by the United States Census Bureau.

Understanding Birth Delivery Costs

On average, a vaginal birth delivery costs around $2,655, while a C-section delivery averages at $3,214.

Variability of Hospital Birth Costs

It is crucial to note that the cost of a hospital birth can vary considerably based on the specific city and state where the delivery takes place.

Average Cost based on Type of Delivery

The method of delivery, whether it is vaginal or C-section, and any complications that may arise can significantly impact the total cost of a hospital birth. While predicting the exact mode of delivery may be challenging, discussing your birth plan and specific risk factors with your prenatal care provider can provide valuable insights.

Vaginal birth

Data collected by Fair Health shows that an average of $28,654 is the cost of undergoing a vaginal delivery.

Cesarean birth

The cost of C-section births, on average, amounts to $37,653, which is higher compared to vaginal deliveries.

According to Dr. Toni Stern, a C-section is a costly procedure due to its nature as a major surgery that involves anesthesia, longer hospital stays, and higher risks of morbidity and mortality. These factors contribute to higher resource utilization and increased expenses.

Premature birth

A premature birth significantly impacts hospital birth costs, occurring in approximately 1 out of 10 pregnancies, with average healthcare expenses for premature and low birth weight infants totaling around $49,140.4

Recognizing the signs of preterm labor and avoiding specific risk factors like excessive exercise, recreational drug use, smoking, and alcohol consumption can help reduce the likelihood of premature labor for The Positive Parent.

Other birth complications

Birth complications can add to the overall expenses. The Positive Parents with high-risk pregnancies or existing medical conditions are at a higher risk of facing complications during labor and delivery.

Being over 35 years old, known as advanced maternal age, can also increase the chances of requiring medical interventions during childbirth. Additionally, The Positive Parents expecting multiples are more prone to incurring greater hospital costs.

How Your Health and Your Baby’s Health Impact Expenses

The well-being of both you and your baby is crucial, not only for overall happiness but also for financial reasons. Factors like stalled labor and the need for induction can significantly affect the costs associated with childbirth. It’s essential to consider how these health aspects can influence the final hospital bill.

Dr. Stern emphasizes that while certain delivery complications may be unavoidable, proper prenatal care can help streamline treatment processes. Building a strong rapport with your healthcare team and ensuring they have comprehensive knowledge of your medical history, medications, and any issues during pregnancy can facilitate a smoother delivery process and potentially lower costs.

Maintaining open communication with healthcare providers throughout prenatal checkups and delivery is essential. By sharing vital information about your health and any concerns, you can help facilitate better decision-making and potentially lower the risk of complications during childbirth.

It’s crucial to recognize that certain health conditions can increase the likelihood of complications during delivery, subsequently impacting costs. Prioritizing your health and well-being can lead to a smoother delivery process and potentially reduce expenses associated with your baby’s birth.

How Health Insurance Coverage Affects Costs

The Positive Parent’s personal health insurance coverage, which includes deductibles, cost-sharing, co-pays, and other factors, along with the choice of health care provider and hospital, plays a significant role in determining the expenses of a hospital birth. Unfortunately, the realm of medical billing and insurance can be intricate and prone to errors.

If you are unsure about your maternity coverage, it’s essential to review it thoroughly. Take the time to carefully examine the benefits summary to comprehend your coverage entirely. Focus on aspects like co-pays, deductibles, out-of-pocket maximums, and the percentage of maternity care covered post-deductible.

Health insurance plays a crucial role in accessing maternity care services in the US and making them financially feasible. However, having maternity coverage does not guarantee full coverage for your maternity care. The extent to which your health insurance plan covers the total cost of your baby’s hospital birth, as opposed to your out-of-pocket expenses, is determined by the specifics of your individual plan.

The impact of the ACA on maternity coverage

Thanks to the Affordable Care Act (ACA), pregnancy is no longer considered a pre-existing condition for most major plans, and pregnancy care and childbirth must be covered in all individual and small group insurance policies.

That means that if you apply for coverage with an ACA-compliant insurance plan while pregnant, the health plan cannot deny you coverage, and pregnancy and maternity care are required to be covered.

In-network versus out-of-network healthcare providers

To lower your total hospital costs and prevent unexpected out-of-network fees, ensure that both your selected provider and the hospital are in-network, meaning they have agreements with your insurance company. It’s essential to verify both aspects because just because your healthcare provider is in-network at a hospital doesn’t guarantee that the hospital is also in-network for your specific plan, and vice versa.

Additionally, it can get more complex when certain specialists like anesthesiologists (for epidurals, C-sections, or surgeries) and neonatal intensive care unit (NICU) staff (for babies needing specialized care) may be out-of-network even if the hospital itself is in-network.

No Surprises Act

Despite the implementation of the No Surprises Act in 2022 by the federal government to restrict unexpected out-of-network expenses for both emergency and non-emergency treatments offered at in-network medical facilities, numerous individuals remain uninformed about their entitlements according to the legislation.

Resources for affordable health insurance

Recent data from the American Community Survey reveals that more than 15% of individuals aged 19 to 34 lack health insurance in the United States. If you require health coverage, The Positive Parent can offer guidance on accessing various health assistance programs.

Schemes like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Children’s Health Insurance Program (CHIP) can assist in finding economical health insurance options if Medicaid is not an option.

Health costs associated with pregnancy, childbirth, and postpartum care. Kaiser Family Foundation. 2022.

Health Insurance Coverage in the United States: 2020. United States Census Bureau. 2021.