Pregnancy Care, Childbirth Led to $19K More in Healthcare Costs

Pregnant women enrolled in large group health plans incurred almost $19,000 more in healthcare costs and spent nearly $3,000 more in out-of-pocket expenses than those who did not give birth, a Peterson-KFF Health System Tracker revealed.

Researchers used claims from the IBM Health Analytics MarketScan Commercial Claims and Encounters Database to determine healthcare costs associated with pregnancy, childbirth, and postpartum care. The data reflects spending from women of reproductive age (15 to 49 years) between 2018 and 2020.

Relative to women who did not give birth, healthcare costs for pregnant women were an average of $18,865 higher. This includes $16,011 paid by insurance and $2,854 paid by the individual in out-of-pocket costs. Out-of-pocket costs reflect amounts paid for cost-sharing under the health plan. Thus, the data does not include out-of-pocket spending on fertility care, as it is often not covered by insurance.

Pregnant women incurred an average of $19,906 more for hospitalizations and outpatient care compared to women who were not pregnant but spent $1,040 less on prescription drugs. Similarly, pregnant women spent $70 less out-of-pocket on prescription drugs compared to women who did not give birth.

Healthcare costs varied for pregnant women depending on whether they had a cesarean section or vaginal delivery.

Total healthcare costs for women who had a cesarean section were $26,280 higher than for those who were not pregnant. This included $23,066 more paid by the health plan and $3,214 more in out-of-pocket costs.

Meanwhile, women who had vaginal deliveries incurred $14,768 more in healthcare costs than women who did not give birth. This figure reflected $12,113 more paid by insurance and an additional $2,655 in out-of-pocket expenses.

“The higher costs associated with pregnancies that result in cesarean section are not only because of the higher cost of the delivery, but also include higher costs before and after the birth, which may be associated with greater service intensity for care of complications or underlying health conditions that can lead to cesarean section and recovery from the surgery,” the brief stated.

While the average total cost of a pregnancy resulting in a cesarean section was 77 percent higher than one resulting in a vaginal delivery, out-of-pocket costs for a cesarean section pregnancy were only 21 percent higher than vaginal delivery pregnancies. This is likely because individuals often reach their deductibles or out-of-pocket maximums following an inpatient admission, researchers noted.

However, the out-of-pocket costs incurred during pregnancy can still pose significant challenges for women and families. According to the brief, around one-third of multi-person households and half of single-person households would not have the finances needed to cover typical out-of-pocket costs for pregnancy and childbirth under private health plans.

Around half of the people who give birth in a given year are covered by private plans, while the other half typically receive coverage from Medicaid.

In addition, medical care for the infant can lead to more out-of-pocket costs. Coupled with potential income losses due to a lack of paid parental leave, out-of-pocket costs can lead new parents to experience medical debt.

A past study from Obstetrics & Gynecology revealed similar findings about how pregnant people with private health insurance experienced higher out-of-pocket costs compared to those with Medicaid and other public health insurance coverage.