Grace and Daniel Griffin of Michigan began planning their finances before conceiving their first child, attempting to estimate pregnancy-related costs through their health insurance provider. Using a summary of benefits and coverage document, they identified an estimated out-of-pocket expense of approximately $2,700 for a routine pregnancy and delivery. However, as medical appointments accumulated during the pregnancy, expenses grew substantially beyond this projection.
The couple faced significant costs from the outset. Grace met her $500 deductible early in pregnancy, and her plan required 20% coinsurance for in-network care. Routine laboratory work, including tests for iron levels and gestational diabetes screening, cost several hundred dollars per visit. After delivering their daughter in June, the hospital charged approximately $18,000 for the delivery, with the family responsible for a considerable share. By early October, their total out-of-pocket expenses had reached more than $9,000, substantially exceeding initial projections.
Research professionals attribute the difficulty in cost prediction to regulatory delays. Sabrina Corlette, a research professor and co-director of Georgetown University’s Center on Health Insurance Reforms, noted that Congress required insurers to provide individualized advanced explanations of benefits estimating scheduled care costs as part of the 2020 No Surprises Act. However, federal regulators have not yet implemented this requirement, despite the rule being due on January 1, 2022. Corlette emphasized that patients have a legal right to this information.
A significant change is approaching. Beginning January 1, 2027, maternity billing codes will shift from bundled arrangements to more detailed coding for prenatal care, labor, delivery, and postpartum care. While this change may increase pricing transparency, experts remain uncertain whether it will provide meaningful benefits to patients attempting to budget for pregnancy expenses.
Parents also face administrative responsibilities following birth. Newborns create special enrollment opportunities, allowing parents to add them to health plans outside regular enrollment periods. Employer plans typically require enrollment within 30 days of birth, while marketplace plans generally allow 60 days. Missing these deadlines can leave newborns uninsured until the following year. Until maternity cost estimation improves, financial planning for pregnancy remains challenging for expecting families.
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