Average Prenatal Care Cost & How Health Insurance Covers It
The amount your obstetrician charges for each visit could range from about $90 to more than $500. Other services, such as ultrasounds and laboratory tests, are typically billed separately and cost upwards of $100 each. And special tests like an amniocentesis can cost more than $2,500.
Women typically have 10 to 15 prenatal visits over the course of a normal pregnancy. If any complications arise, there may be even more.
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Your out-of-pocket cost will depend on whether you have health insurance and the prenatal care is considered routine or diagnostic.
For example, any visit that goes beyond routine and becomes diagnostic can be subject to cost sharing under the terms of your insurance plan. Also, your insurance company may expect you to chip in for some care that might seem routine, such as blood work, obstetric ultrasounds or not-routine-for-everyone prenatal testing.
There's some good news for those who do have insurance. The Affordable Care Act requires all qualified health insurance plans to cover routine prenatal care with no cost sharing. That means no copays or coinsurance, and the visits are fully covered even if you haven't met your deductible yet.
Women who don't have health insurance must pay the entire cost of their prenatal care.
How health insurance covers the cost of your prenatal visits
If you have health insurance, preconception counseling is one of the services covered with no cost sharing under the Affordable Care Act. It's smart to visit your doctor or gynecologist even before you conceive to get a basic checkup and ask questions about your pregnancy plans.
This is a good time to talk to your doctor about the best prenatal vitamins, especially folic acid supplements. Folic acid is recommended for all women who might become pregnant, because it helps prevent birth defects like spina bifida and anencephaly. If you have insurance, make sure you get a prescription for your prenatal vitamins from your doctor, because your insurance company will cover certain brands in full. If you buy them over the counter, you won't be reimbursed.
Prenatal services, tests and exams are priced differently, depending on their categorization as routine or diagnostic.
The cost of routine prenatal visits vs. diagnostic visits
At prenatal visits, your doctor will monitor your health and the baby's. They'll probably check your urine, your blood pressure, your weight and the fetal heart rate. As your pregnancy progresses, your doctor will also measure your abdomen and feel for the baby's position. If you have health insurance, all of this routine prenatal care should be covered by your health insurance plan, with no charge to you.
If the obstetrician detects anything worrisome during the exam or you bring up a concern that requires investigation, though, the billing code for your visit may change from routine to diagnostic. The doctor needs to figure out the problem and may have to order extra tests. This diagnostic prenatal care is generally not required to be covered by insurance without cost sharing. So, you may be responsible for copays, coinsurance or payments toward your deductible, depending on the structure of your health insurance plan.
The cost of routine screening tests during pregnancy
The health care law requires insurance plans to cover certain screening tests for pregnant women with no cost sharing. These are generally done as part of regularly scheduled prenatal visits, often through blood work or urine tests. The free routine screening tests covered by your health insurance plan should include, but are not limited to:
- Anemia screening
- Bacteriuria (urinary tract) or other infection screening
- Rh incompatibility screening and follow-up testing for women at higher risk
- Hepatitis B screening at your first prenatal visit
- Gestational diabetes screenings at 24 to 28 weeks — and at other times if you are at high risk
- Syphilis screening
You can also get — fully covered — the screenings and services available to all women, such as tests for HPV, cervical cancer, HIV, gonorrhea and chlamydia, as well as counseling for things like domestic violence and tobacco use.
Screening tests that aren't mandated by the Affordable Care Act may mean out-of-pocket payments from you, based on your insurance plan's cost-sharing structure.
If you have a pregnancy with no concerns or complications, your prenatal care may be free if you have a generous insurance plan and stay within your network. Everyone else will probably have some out-of-pocket costs, such as copays or coinsurance for blood work or ultrasounds. Some women may even pay the full costs of tests until the deductible is met. In addition, most new parents can expect a big bill for labor and delivery.
Prenatal care without health insurance
If you're pregnant with no health insurance, now would be a really good time to see if you can get it. Pregnancy is common, but it's also incredibly expensive. From 2018 to 2020, the average cost of having a baby, including prenatal care, vaginal delivery and the first three months of newborn medical care, was about $19,000, according to a study from the IBM Health Analytics MarketScan Commercial Claims and Encounters Database. For cesarean sections (also known as C-sections), that number was about $27,000.
If you don't have access to health insurance through an employer or parent, consider buying an individual policy on your state's marketplace or the federal exchange. You can only sign up for coverage during the open enrollment period, though, unless you experience a qualifying event, such as losing your insurance, moving to a new state or getting married.
Beware: Getting pregnant is not a qualifying event for health insurance. Consumer groups and federal legislators have been advocating to add a special enrollment period for pregnant women, to ensure access to prenatal care. However, opponents worry this would create an incentive for women to forgo insurance until it's needed for pregnancy costs.
One option for many expectant mothers is Medicaid or a state-sponsored program. A lot of states loosen their income requirements for pregnant women to offer them free health insurance.
Even if you don't have health insurance, you should get prenatal care for the sake of your health and your baby's. Children born to mothers who don't get prenatal care are five times more likely to die, compared with infants born to mothers who go to the doctor regularly while pregnant. And mothers who don't get this important medical attention are three to four times more likely to die.
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