Out-of-pocket costs of having a baby can be ‘staggering’

"The increasing maternal health costs burdening families over time is concerning, says Michelle Moniz. "Research tells us that out-of-pocket costs for healthcare are often associated with skipped care." (Credit: Getty Images)

One of the most expensive parts of having a baby may involve the birth itself, a new study suggests.

Despite an Affordable Care Act mandate that requires large, employer-based health plans (used by about 50% of women in the US) to cover maternity care, many families still shoulder a big brunt of the costs.

As reported in Health Affairs, average out-of-pocket health care spending for maternity care—including pregnancy, delivery, and three months postpartum—jumped from $3,069 in 2008 to $4,569 in 2015.

The reason: while the ACA requires full coverage of preventive services, such as pap smears and mammograms, there are few restrictions on how plans impose co-pays, deductibles, and cost-sharing for maternity care.

“We were surprised to learn that the vast majority of women paid for critical health services tied to having a baby,” says Michelle Moniz, a researcher with the University of Michigan Institute of Healthcare Policy and Innovation and an obstetrician gynecologist at Michigan Medicine’s Von Voigtlander Women’s Hospital.

“These are not small co-pays. The costs are staggering.”

The study included a national sample of 657,061 women enrolled in 84,178 employer-sponsored plans hospitalized for childbirth from 2008 to 2015. Researchers analyzed costs for all health care services used before and after delivery that might influence pregnancy outcomes.

Researchers found that 98% of the women were paying some out-of-pocket costs.

Childbirth is a leading reason for hospitalization among women of reproductive age. Not surprisingly, out-of-pocket costs for cesarean sections are higher, with mean total out-of-pocket spending rising from $3,364 in 2008 to $5,161 in 2015 for C-sections compared to an increase of $2,910 to $,4314 for vaginal births.

Women also seem to be bearing a higher proportion of total costs. Those with vaginal births covered 21% of expenses in 2015 compared to 13% in 2008. Women with C-sections could expect to pay about 15% of costs, up from 10% during the same years.

Maternity care services are vital to ensuring the best possible outcomes for moms and newborns, Moniz says. This is an especially important focus as data over recent years suggests that the US continues to defy global trends as one of the only developed countries with a rising maternal mortality rate.

“The increasing maternal health costs burdening families over time is concerning. Research tells us that out-of-pocket costs for healthcare are often associated with skipped care,” Moniz says.

“These financial burdens put women at risk of delaying or missing maternity care, which we know can lead to poor outcomes for women and babies. Restricting patient spending for maternity care may be an important opportunity to improve maternal and neonatal health for American families.”

Higher deductible plans and co-pays, along with possible misconceptions about what the ACA requires for maternity health care coverage, may be areas advocates and lawmakers could target for improvement, Moniz says.

“There is strong rationale for policymakers to consider policies to protect the average consumer,” Moniz says.

“Maternity and childbirth care are essential health services that promote the well-being of families across our country. Reducing patients’ costs for these high-value services makes sense. We all want babies to have the best possible start in life.”

Source: University of Michigan