As Grace Griffin and her husband were welcoming their long-awaited baby — a daughter — Griffin found herself worried about looming medical bills and unsure whether the family could pay for the care needed.
"This whole experience has me wondering (keeping me up at night, actually): Can we ever afford to have another child?"
— Grace Griffin, Calumet, Michigan
Grace and Daniel Griffin, both 26, knew money would be tight once they had their first child. So, even before the Calumet, Mich., couple tried to conceive, they began crunching the numbers to figure out the cost of pregnancy.
"We wanted to save up enough to pay for those medical bills right away, if possible," Grace said.
But the cost estimator that she found linked to her UnitedHealthcare student plan asked for medical billing codes for each procedure that Grace was likely to receive. That's information she didn't have.
So, she kept digging until she found the Summary of Benefits and Coverage information on the health plan's website, which estimated out-of-pocket costs for a routine pregnancy and delivery at about $2,700.
"We thought, 'OK, that's doable,'" she said. "We should be able to save up that much and pay for that out of pocket."
But as the expenses piled up, it was clear the estimate wasn't even close.
Early in the pregnancy, Grace met her $500 deductible, the out-of-pocket cost she had to pay before insurance pitched in. Her plan also required her to pay 20% coinsurance for in-network care. This meant that for every $100 billed for things like routine blood work and other needed care, she was on the hook for $20.
"When I started getting lab work is when we started realizing expenses would add up quickly," Grace said. Routine blood tests to check iron levels or for gestational diabetes were a couple of hundred dollars every visit, she said.
In June, after what Grace described as a routine pregnancy and delivery, the couple welcomed their daughter. Then the Griffins received an "explanation of benefits" notice that showed the hospital charged about $18,000 for the delivery, with the family on the hook for a sizable portion.
"I thought, 'Oh no, it's going to be a lot,'" she said. "Much more than we budgeted for."
She was right.
In early October, Grace said, her family's out-of-pocket expenses had totaled more than $9,000, over three times the general estimate published by her insurer for pregnancy-related costs.
Meanwhile, Grace and Daniel are scrambling to cover their bills.
For years, federal lawmakers have tried to remedy this issue, said Sabrina Corlette, a research professor and co-director of Georgetown University's Center on Health Insurance Reforms. To make healthcare costs more transparent and accessible to patients, Congress required insurers to provide consumers with an individualized "advanced explanation of benefits" estimating what scheduled care would cost them. The rule, part of the 2020 No Surprises Act, was due to take effect on Jan. 1, 2022, but federal regulators have yet to make that happen, despite ongoing pressure from members of Congress.
"So, it's basically 4 1/2 years since this was supposed to be available, and I think it's a source of a lot of frustration for a lot of folks," Corlette said. "People have a right under the law to know these things."
Meanwhile, she said, another change is pending. Beginning Jan. 1, 2027, long-standing maternity billing codes that bundle much of pregnancy care will be replaced with more detailed coding for prenatal care, labor, delivery and postpartum care.
The change could make it easier to see what individual services cost, but Corlette said it's not yet clear whether the change will make it easier for people trying to stick to a budget.
"I could see where it might be advantageous to the provider," she said. "But I'm not sure I'm seeing benefits to the patient."
Until out-of-pocket maternity expenses get easier to estimate, here are some tips to help you budget for the cost of pregnancy.
1. Enroll your baby before the clock runs out
Ensuring your newborn has health coverage is one of the first paperwork responsibilities that parents face in the whirlwind of bringing a baby home.
Birth creates what's known as a special enrollment opportunity, meaning you don't have to wait until the annual open-enrollment period to sign up a newborn.
Many employer health plans require parents to request enrollment within 30 days of birth. Marketplace plans — for those who buy their own insurance rather than get it from an employer or the government — generally allow 60 days. Wait too long, and your baby may be left uninsured until the following year.
Michelle Critzer of Ventura, Calif., learned that lesson the hard way. She works as a sales rep and is the mother of a toddler and a newborn. Her second son, Hudson, was born in February, and Critzer missed the enrollment deadline for him. Ever since, she has been asking her insurer to make an exception — so far, without success.
"The way they set hard must-do's within 30 days of having a baby is actually insanity," she said.
The family was able to enroll Hudson in a health plan through Critzer's husband's workplace, which has a 60-day enrollment window. But that coverage is not nearly as robust as Critzer's insurance, she said. Still, she's grateful to have Hudson insured while she continues pressing her own plan to enroll him.
2. Ask about must-know numbers, like your MOOP
Budgeting for a pregnancy often begins with a tally of the expected expenses. The deductible is the amount you'll pay before much of your insurance coverage kicks in.
After that, you'll likely face copayments — fixed fees paid each time you receive service, regardless of the size of the bill.
Coinsurance is another expected expense, but as Grace discovered, it can be especially tricky to estimate. Coinsurance requires the patient to pay a percentage of the cost for each service received.
MOOP, which stands for "maximum out-of-pocket" expense, is another must-know number. Your plan's MOOP is the ceiling on what you'll pay each year for covered, in-network services (care that your health plan has contracted to pay at negotiated, lower rates).
Think of it as doomsday prepping. Some people get comfort from knowing and planning for the worst-case scenario. Under the Affordable Care Act, in 2026 the amount a person has to pay out of pocket for in-network care is capped at $10,600 for an individual and $21,200 for a family. Your plan might set a lower maximum, but once your spending reaches your plan's limit, insurance pays 100% of all further in-network costs for that year.
One complication to be aware of: If your pregnancy overlaps two plan years, the tally of your out-of-pocket expenses resets to zero at the beginning of the second year, and you could find yourself maxing out your out-of-pocket expenses two years in a row.
Some plans have two MOOPs, one for in-network services and another for out-of-network benefits. Insurance plans usually track those expenses separately, and the out-of-network MOOP can be double the in-network limit. That's more incentive to meticulously seek out in-network care.
As a family, the Griffins had an $18,000 MOOP, and Grace's individual maximum was $9,000.
3. Choose in-network care, when you can
You picked an obstetrician in your plan, but don't assume others on the care team are in-network providers.
Ask about the hospital, labs and imaging facilities your doctor's office may use. Corlette, of Georgetown's Center on Health Insurance Reforms, suggests that patients explicitly tell the doctor's office to send tests to an in-network provider.
Federal law protects patients who go to an in-network hospital or other in-network facility from out-of-network "surprise bills" issued by out-of-network providers.
4. Check every bill — and don't be afraid to file an appeal
The Affordable Care Act requires certain recommended prenatal services to be covered without any additional cost to you. Among them: prenatal visits, folic acid, anxiety and depression screening, and breastfeeding and lactation counseling and supplies.
Still, these costs sometimes get mistakenly passed on to the patient.
To protect against billing errors, Corlette suggests patients become familiar with these pregnancy-related services and then check every bill.
If your insurer refuses to pay for a covered charge, consider filing an appeal.
5. Seek help before the bills pile up
Most hospitals offer financial assistance programs. Find out whether yours will work with you, either to reduce your bill or to offer a manageable payment plan. Your doctor or other providers might also offer assistance, if you ask.
Corlette said to make sure any arrangement is formally agreed upon in advance so the account isn't unexpectedly turned over to collections.
Also investigate other assistance.
Grace Griffin qualified for Michigan's Rx Kids program, which provides eligible families in certain communities with $1,500 during pregnancy and $500 a month for the baby's first six months or year of life.
That money has helped keep the medical bills from devouring the Griffins' emergency savings.
"It takes a lot of pressure off," she said.
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