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Parents may face a hefty hospital bill just as other baby-related expenses are adding up. Getty Images
  • The out-of-pocket costs of having a baby went up 50 percent from 2008 to 2015 for insured women.
  • With employee insurance, the average out-of-pocket cost to give birth is $4,569 on average.
  • Experts point out this high expense comes at a time when many families are facing diminished income and other financial strain related to the new baby.

Giving birth in the United States is increasingly an expensive endeavor — even for parents who have insurance.

A new study found that the out-of-pocket cost of having a baby went up 50 percent from 2008 to 2015 for insured women.

The reason for this is complicated.

To help women pay for the costs of delivery and other maternity services, the Affordable Care Act requires large group employer-sponsored insurance plans to provide coverage for maternity care.

But employer-based plans are still permitted to apply cost-sharing charges to many types of maternity care. Those charges may include copays, coinsurance payments, and deductible payments.

As a result, many women with employer-based plans continue to pay thousands of dollars out of pocket for maternity services.

According to the new study published in Health Affairs, women with employer-based plans who gave birth in 2008 paid $3,069 on average in out-of-pocket spending for maternity care. Those who gave birth in 2015 paid $4,569 on average — or nearly 50 percent more.

The total standardized cost of maternity services remained relatively stable over that time period. But women with employer-based plans paid a growing portion of the cost, due in large part to growing deductibles.

“Our findings suggest that the general trend in rising out-of-pocket spending has affected workers’ spending for maternity care, with the growth of high deductible health plans driving much of the increase in out-of-pocket spending,” the authors of the study wrote.

“Policies that aim to lower out-of-pocket spending for maternity care could reduce a significant financial burden on families,” they added.

The new study was conducted using data drawn from Clinformatics Data Mart database. This database includes information about claims made by people enrolled in commercial health insurance plans sponsored by medium- or large-sized employers based in the United States.

The authors of the study analyzed data for more than 650,000 women across the country who had been hospitalized for childbirth resulting in a live birth between 2008 and 2015.

They included healthcare services that were claimed for participants during the 12 months before delivery, during hospitalization for delivery, and up to 3 months afterward.

This would include prenatal and postnatal care for the women, as well as other healthcare services that the women might have used to manage chronic diseases or other conditions during that time period.

However, the authors didn’t factor in the cost of healthcare services provided to newborn infants. These services can be expensive, even when a baby is born without serious birth issues or injuries.

“The new study appears to be well done,” Carol Sakala, PhD, director of Childbirth Connection programs at the nonprofit organization National Partnership for Women & Families (NPWF), told Healthline.

“However,” she added, “it did not include the generally considerable costs for services provided to the newborn and some others that families also may pay at this time.”

Past research on this topic has also found that out-of-pocket spending is on the rise for people with private health insurance, including pregnant women.

“In our own commissioned study on The Cost of Having a Baby in the United States, we reported that out-of-pocket maternal healthcare costs for women with private insurance increased nearly fourfold from 2004 to 2010,” Sakala said.

“In our third national population-based Listening to Mothers survey of women who gave birth in 2011 and 2012,” Sakala continued, “just 7 percent of women with private insurance reported having no out-of-pocket costs, and average reported total out-of-pocket cost for women with private insurance was $3,402.”

These healthcare expenses often come at a time when families are coping with reduced income, due to the limited availability of paid family and medical leave benefits, Sakala added.

The costs of diapers, childcare, and other expenses of caring for a new family member also add to the financial strain that many families face.

When faced with high deductible payments and other out-of-pocket charges, women with employer-based health insurance may struggle to afford the costs of maternity services.

In some cases, this may prevent them from accessing health services that many experts consider to be important for promoting good health outcomes in pregnant women and newborn infants.

“The issue is when women pay more out of pocket, and employers’ plans pay less, you may have less people take advantage of preconception and prenatal care,” Dr. Jill Maura Rabin, vice chair of education and development for obstetrics and gynecology at Northwell Health, in New Hyde Park, New York, told Healthline.

When women are planning to get pregnant, preconception care can help them manage chronic conditions such as diabetes that may affect their pregnancy and developing fetus later on.

Healthcare professionals can also prescribe folic acid supplementation and other treatments to promote a healthy pregnancy, while monitoring the woman and fetus for potential health issues.

Prevention and treatment of potential health problems during this time helps to reduce morbidity and mortality among pregnant women, developing fetuses, and newborn children.

In turn, this leads to healthier families and lower healthcare costs.

To help promote good health outcomes and lower the costs of care for pregnant women and children, Rabin suggested that employers, health insurers, healthcare systems, and policymakers strive to reduce barriers to maternity care by limiting out-of-pocket charges.

“I think that over time, it would be prudent for employers and hospitals to consider not making [cost sharing] a barrier to access for people who can’t afford it,” Rabin said.

“These women are carrying future pediatric patients,” she continued, “and a healthy child is much less costly, emotionally and financially, to the family and the healthcare system than a sick child.”

In the long run, she said that upfront investments in preconception and prenatal care can save a lot of money.

The ACA’s preventive care provisions do currently require zero cost sharing for some maternity services, including gestational diabetes screening.

But it can be challenging to put that policy into practice in a context where many healthcare providers are bundling services rather than billing for them individually.