Guides Choosing a plan when you're expecting
Choosing a health plan when you're expecting a baby
A birth is one of the most predictable big medical bills there is, which makes it easier to plan for than most. The key is the out-of-pocket maximum, and when the bills land.
What a birth costs
For people with employer coverage, pregnancy, childbirth and postpartum care cost about $20,416 more on average than for people who didn't give birth, including $2,743 paid out of pocket. That's an average across plans; on a high-deductible plan your share can be much more.
| Average cost, employer plans | Total | Paid out of pocket |
|---|---|---|
| Vaginal birth, with pregnancy and postpartum care | $15,712 | $2,563 |
| C-section, with pregnancy and postpartum care | $28,998 | $3,071 |
| Newborn, first months of coverage | $5,820 | $475 |
By 18 to 24 months old, children who had a stay in neonatal intensive care (NICU) had about $77,992 in health costs, against $14,268 for those who didn't. Figures from Peterson-KFF, claims from 2021 to 2023.
Why the out-of-pocket maximum matters most
With bills this size, you'll likely meet the deductible and may reach the out-of-pocket maximum, whichever plan you choose. So the most useful comparison is each plan's premiums for the year plus its out-of-pocket maximum, minus any employer HSA money. Once the baby is on your plan, they're a new person on it, often with their own deductible inside the family one.
Some prenatal screenings are preventive care, which most plans cover at no cost. Ultrasounds, lab work, the hospital stay and the delivery itself usually count toward the deductible.
Timing: plan years and adding your baby
- Plan years reset. Prenatal care before January counts under this year's plan. A birth in the new plan year starts that plan's deductible from zero.
- Add your baby within 30 days. Employer plans must let you add a newborn within at least 30 days of the birth, and coverage goes back to the date of birth.
- Premiums go up from the birth. Adding your baby moves you to a higher coverage level, such as employee plus children or family, usually from the birth date or the next month.
- Pick the right parent's plan. If you both have coverage through work, the baby can go on either parent's plan, as long as that parent is on it.
A worked example: PPO or HSA plan for a birth
Made-up numbers for the person giving birth, before the baby is added, with a typical birth at about $15,700 in negotiated prices.
| PPO | HSA plan | |
|---|---|---|
| Deductible, coinsurance, out-of-pocket maximum | $1,000, 20%, $4,000 | $3,500, 20%, $7,000 |
| Premiums for the year | $3,120 | $1,170 |
| Your share of the birth | $3,940 | $5,940 |
| Employer HSA money | $0 | −$1,000 |
| Total | $7,060 | $6,110 |
Here the HSA plan still costs less, because its lower premiums and the employer's deposit outweigh its higher share of the bills. With a smaller premium gap or no HSA deposit, the PPO would win. A C-section or a NICU stay pushes both plans to their out-of-pocket maximums, so the worst cases are worth comparing too.
Do it with your own numbers
Tick “We're expecting a baby” on your HerePup answer and add the due month. HerePup adds the usual costs of the pregnancy, the birth and the baby's first year, at national average prices, to your own claims, and shows which plan costs least for a typical birth, a C-section or a NICU stay. Your due date stays on your device.
Free. Your benefit guides and claims are read on your device and never uploaded.
Questions people ask
Is a high-deductible plan a bad idea when you're pregnant?
Not necessarily. A birth usually brings you close to the out-of-pocket maximum on any plan, so compare each plan's premiums plus its out-of-pocket maximum, minus any employer HSA money. A high-deductible plan with low premiums and a generous HSA deposit can still cost less. Make sure you could cover the deductible when the bills arrive.
When do I add my baby to my health insurance?
Employer plans must give you at least 30 days after the birth to add your baby, and coverage goes back to the date of birth. Check your plan's deadline; some give longer.
Can I change plans when I find out I'm pregnant?
Usually not. Under federal rules, a birth lets you change employer coverage, but a pregnancy on its own usually doesn't. That's why open enrollment before a due date matters.
What if my baby is due in January?
Then prenatal care in the fall counts under this year's plan, and the birth starts next year's deductible and out-of-pocket maximum from zero. You could reach the out-of-pocket maximum in both years, so check both plans' worst cases.