Pregnancy costs frequently exceed insurer estimates, and federal transparency rules remain unimplemented
Pregnancy and childbirth in the United States carry significant out-of-pocket costs that can far exceed insurers' published estimates. A provision of the 2020 No Surprises Act requiring insurers to provide individualized, advance cost estimates was due to take effect January 1, 2022, but federal regulators have not implemented it. Beginning January 1, 2027, longstanding bundled maternity billing codes will be replaced with more granular coding for prenatal, delivery, and postpartum services.
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Grace Griffin, 26, of Calumet, Michigan, used her UnitedHealthcare student plan's published estimate to budget for a routine pregnancy and delivery. The insurer's Summary of Benefits and Coverage document estimated out-of-pocket costs at approximately $2,700. Her actual out-of-pocket expenses exceeded $9,000 — more than three times that figure — after the hospital billed roughly $18,000 for delivery alone.
Griffin's experience illustrates several common cost drivers. Her plan required her to meet a $500 deductible before insurance contributed, and then pay 20% coinsurance on in-network services. Routine lab work — blood tests for iron levels and gestational diabetes — ran several hundred dollars per visit. The family's plan carried an individual maximum out-of-pocket (MOOP) of $9,000 and a family MOOP of $18,000, which is the ceiling on annual in-network spending under that plan.
Sabrina Corlette, a research professor and co-director of Georgetown University's Center on Health Insurance Reforms, told NPR that the federal government's failure to implement the advance explanation of benefits requirement from the No Surprises Act has left patients without a tool Congress intended them to have. "People have a right under the law to know these things," Corlette said, noting it has been approximately four and a half years since the rule was supposed to take effect.