Blog

Planning For Baby: What Health Care Costs to Expect When You’re Expecting

Having a family is a lifelong dream for many, and when that day arrives, whether you want it to or not, your life changes forever.

While expecting a baby is exciting, understanding what health care services are covered by the Affordable Care Act (ACA) and your insurance company can be confusing.

Under the ACA, pre­- and post-maternity and delivery care are covered as an essential benefit of your health insurance coverage, however, each state has the right to exclude specific services related to maternity care and delivery. This can leave some paying for maternity services and well baby visits after delivery, so it’s important to know what your state mandates as “essential” for you and your baby. And keep in mind that the average vaginal delivery costs over $9,000 and the average delivery by c-section costs over $12,000. Paying attention to your health insurance deductible and annual out-of­-pocket maximum is important.

Pregnancy-­Related Services Covered

These pregnancy­-related services qualify as preventive care, and are covered at 100% under ACA plans (no copay or coinsurance, regardless of deductible) :

  • Contraception
  • Folic acid
  • Breastfeeding support & counseling
  • Gestational diabetes screening
  • Gonorrhea and Hepatitis B screening
  • Tobacco counseling
  • Annual well­-woman visits

Prenatal Visits

The ACA requires insurance plans to cover these visits, but patients should check with their insurance carrier to determine how their prenatal visits are covered at 100% in their state of residence.

Delivery

Services to deliver a baby are also covered under ACA plans, but like prenatal visits, patients should check with their insurance company to see what stages of “delivery” are covered.

State by State Guide

To help you understand what you might be financially responsible for when your baby arrives, here is a list of services by state that are covered or excluded when you become pregnant and have a baby.

Alabama Maternity services for dependent children are excluded. Well baby visits are not covered.
Alaska Prenatal, postnatal and delivery services are covered, but deductible and coinsurance still applies.
Arizona Most deliveries in birthing centers are not covered. Well baby visits are covered up to 47 months.
Arkansas Certain delivery and inpatient maternity services are not covered. Check with your health insurance company for details about what you are responsible for.
California Scheduled prenatal exams and first postpartum follow­up consult is covered without charge.
Colorado No exclusions.
Connecticut Home deliveries are not covered unless of emergency. Well baby visits are not covered.
Delaware Well baby visits are not covered.
District of Columbia Well baby visits are not covered.
Florida Maternity services of covered person are not covered for surrogate births. Care for the mother includes the postpartum assessment. Well baby visits are not covered.
Georgia Maternity services of covered person are not covered for surrogate births. There is a 48 hour minimum length of stay for vaginal delivery; 96 hour minimum length of stay for cesarean delivery. Well baby visits are not covered.
Hawaii No exclusions.
Idaho No coverage for dependent daughters. If newborn is added to health insurance policy upon delivery, NICU is covered.
Illinois Includes lactation support. Well baby visits are not covered.
Indiana Maternity services of covered person are not covered for surrogate births. There is a 48 hour minimum length of stay for vaginal delivery; 96 hour minimum length of stay for cesarean delivery.
Iowa Maternity services of covered person are not covered for surrogate births. Minimum maternity stay requirements of 48 hours for vaginal delivery or 96 hour minimum length of stay for cesarean delivery, unless attending provider and mother choose otherwise.
Kansas Prenatal and postnatal care, delivery and all inpatient services for maternity care include surrogate mother.
Kentucky Maternity services of covered person are not covered for surrogate births. There is a 48 hour minimum length of stay for vaginal delivery; 96 hour minimum length of stay for cesarean delivery.
Louisiana Maternity services for dependent children are excluded. A pregnancy care copayment, if shown in the insurance schedule of benefits, applies to each pregnancy for covered services rendered by in­network providers. An authorization is required for a hospital stay in connection with childbirth for the covered mother or covered well newborn child only if the mother’s length of stay exceeds 48 hours following a vaginal delivery or 96 hours following a cesarean section. An authorization is required if a newborn’s stay exceeds that of the mother. Well baby visits are not covered.
Maine Maternity services are not covered for surrogate births. Well baby visits are not covered.
Maryland No exclusions.
Massachusetts Maternity services are not covered for surrogate births. Planned home birth is excluded.
Michigan No exclusions.
Minnesota Well baby visits are not covered.
Mississippi Maternity services for dependent children are excluded. Well baby visits are not covered.
Missouri Maternity services are not covered for surrogate births. There is a 48 hour minimum length of stay for vaginal delivery; 96 hour minimum length of stay for cesarean delivery. Well baby visits are not covered.
Montana No exclusions.
Nebraska Maternity services are not covered for surrogate births. Well baby visits are not covered.
Nevada No exclusions.
New Hampshire Maternity services are not covered for surrogate births. There is a 48 hour minimum length of stay for vaginal delivery; 96 hour minimum length of stay for cesarean delivery. Well baby visits are not covered.
New Jersey Private accommodations are excluded. Mother may elect a home care program in lieu of the post­delivery hospital stay.
New Mexico Well baby visits are not covered.
New York There is a 48 hour minimum length of stay for vaginal delivery; 96 hour minimum length of stay for cesarean delivery.
North Carolina Maternity services for dependent children are excluded except for state mandated complications of pregnancy and federally mandated services. Maternity services are not covered for surrogate births.
North Dakota Genetic tests to solely determine sex of baby are excluded.
Ohio Maternity services are not covered for surrogate births if person covered by the insurance policy is not the surrogate. There is a 48 hour minimum length of stay for vaginal delivery; 96 hour minimum length of stay for cesarean delivery.
Oklahoma Well baby visits are not covered.
Oregon No exclusions.
Pennsylvania Precertification required for out­of­network care. Benefits will be reduced by 50% per service or supply if precertification is not obtained. Well baby visits are not covered.
Rhode Island No exclusions.
South Carolina Services for surrogates and dependent children are excluded. Well baby visits are not covered.
South Dakota Excludes maternity care if the mother is a surrogate mother. There is a 48 hour minimum length of stay for vaginal delivery; 96 hour minimum length of stay for cesarean delivery. Well baby visits are not covered.
Tennessee No exclusions.
Texas Employer coverage of small groups with 15 employees or less are allowed to choose whether to provide maternity benefits. Check with your insurance company.
Utah Well baby visits are not covered.
Vermont Some maternity office visits and inpatient hospital services are considered additional benefits. Contact your insurance company for details.
Virginia Maternity services are not covered for surrogate births if person covered by the insurance policy is not the surrogate. There is a 48 hour minimum length of stay for vaginal delivery; 96 hour minimum length of stay for cesarean delivery.
Washington Maternity services for dependent children are excluded. Well baby visits are not covered.
West Virginia Services for surrogate motherhood are not covered. Newborn care is covered when baby is added to family health insurance plan within 30 days of birth. All covered services must be medically necessary unless otherwise specified. Well baby visits are not covered.
Wisconsin Well baby visits are not covered.
Wyoming Services for surrogate motherhood and dependent children are not covered. Well baby visits are not covered.

Special Open Enrollment

It’s important for new parents to remember that having a baby qualifies them for the special open enrollment period, meaning they can make changes to their existing health insurance coverage when adding baby on to their health insurance policy.

HealthValues is an organization helping Christians become wiser with money, create collective buying power and advocate for smarter health care solutions.