How much does it cost to have a baby in the United States of America? Many web-based resources quote average figures ranging from $10,000 to $15,000 for uncomplicated vaginal or cesarean deliveries.
Unfortunately, average numbers don’t help parents with their pre-baby financial planning and preparation. The range of outcomes is simply far too wide. Parents need to forecast out-of-pocket spending unique to their situation.
In addition, parents-to-be must budget for expenses outside of a brief hospital stay because each phase (conception, pregnancy, childbirth, and first year) has often unforeseen factors affecting their total cost.
Below, we break down the key variables in each of the four phases. Note the unusual factors in your checklist. Prepare for the worst, but hope for the best.
Trying to Conceive: Cost for Couples
Conception is the first place where the average cost of having a baby proves misleading. The range of actual out-of-pocket expenses for couples in the USA is literally and figuratively all over the map.
Several factors determine what hopeful parents might spend on conception alone.
- The majority of couples conceive naturally and spend nothing
- Up to 15% of couples are unable to conceive after 12 months using natural methods (1)
- Per-attempt prices for infertility treatments range from $5 to $20,000
- Success rates drive the number of attempts couples must fund
- Most health insurance plans do not cover treatments unless subject to a mandate
- Only 15 states have laws requiring coverage
- Each law contains different exclusions and limitations
Couples who are able to conceive after just of few attempts of first-line infertility treatments (such as fertility drugs or artificial insemination) face lower expenses. Reproductive endocrinologists often recommend a variety of treatments depending on the underlying cause.
Each option has a unique price point as these examples show.
- Prescription fertility drugs range from $10 per pill to $2,000 for a round of injections
- Artificial insemination is $200 to $800 per attempt
- Tubal ligation reversal surgery is roughly $10,000
- Vasectomy reversal surgery charges range from $5,000 to $20,000
The success rates for each of these procedures also have a wide range and downstream implications.
- Low success rates mean more cycles and extra spending
- High success rates mean fewer cycles and less spending
Endocrinologists often promote high success rates using follicle-stimulating hormones. This results in more eggs available for fertilization. In turn, this leads to an increased rate of multiple pregnancies, which carry higher risks of medical complications and preterm birth.
Couples feel the financial consequences six to nine months later. See below.
In Vitro Fertilization
In Vitro Fertilization (IVF) offers couples the hope of better success rates. However, it comes with a much higher per-attempt price tag. Patients should budget to spend up to $50,000 (3 cycles) just to conceive using this method.
The actual expenditure depends on the price and number of cycles, whether a state insurance mandate applies, and the type of financing used.
Breakdown by Service
The per-attempt cost of IVF starts at $12,000 and projects a 25% overall success rate. Many couples then take calculated gambles to increase success rates (lower the number of cycles needed) or avoid inherited defects. All of these optional services add to hidden or actual expenditures.
- Multiple embryo transfers promote twins
- Donor eggs: $17,000
- Donor sperm: $2,000
- Intracytoplasmic Sperm Injection: $2,000
- Preimplantation Genetic Diagnosis: $1,800 to $3,500
Breakdown by State
Access to an insurance plan that covers some or all IVF expenses has the most profound impact on out-of-pocket conception costs. Fifteen state legal mandates may apply to some couples and certain therapies.
Most young couples simply do not have $50,000 in spare cash lying around to fund their out-of-pocket conception costs. They have to borrow the money and pay it back monthly over time.
Borrowing costs are an overlooked consideration. Each option has unique fee structures.
- IVF financing programs often include multi-cycle commitments
- Unsecured loans include origination fees and interest charges
- 401K loans impose income taxes if the person leaves his or her employer
However, the hidden costs of borrowing money pop up six or nine months later during a high-risk and/or multiple pregnancies (twins, triplets). Stay tuned below.
During Pregnancy: Cost Breakdown
During mom’s pregnancy is when we see income, the projected due date, and where she works factor into the out-of-pocket cost breakdown. All three variables influence a family’s ability to access insurance that will minimize expenses.
These three factors have varying impacts on pregnant tests, prenatal care, and medical complications.
Tests & Ultrasounds
Expectant women without health insurance often find that pregnancy tests and ultrasounds are the one area where costs are not a great concern.
Faith-based pregnancy resources centers across the country offer free pregnancy confirmation ultrasounds. You can tap into these free resources to verify fetal viability and to obtain the documentation needed to enroll in Medicaid.
There should be no need for most to pay for these services out-of-pocket. Contact a center in your local area. They should be happy to help.
The out-of-pocket cost of prenatal doctor visits is where we first see an extremely wide range of outcomes for women who are able to conceive. The mother’s ability to access medical insurance and her health during the nine months before delivery are the primary factors affecting affordability.
Most individuals can find low-cost health plans that pay for most prenatal care expenses – even if they were uninsured prior to conception. However, a small group with higher incomes may strike out if their due date falls between October and December (see enrollment periods).
- Pregnancy Medicaid offers expanded eligibility compared to regular Medicaid. Women dealing with unplanned pregnancies can enroll any time – if they qualify based on the higher income criteria.
- Individual Obamacare plans cover pre-existing pregnancies with no waiting period. Women who make too much for Medicaid often qualify for government subsidies that lower premium costs.
The average cost of dental work during pregnancy has another set of unique considerations, which of course depend on access to insurance coverage. The American Pregnancy Association recommends delaying cosmetic and elective procedures until after childbirth. On the other hand, routine preventive care such as cleanings is now critically important. (2)
During pregnancy, rises in hormone levels causes the gums to swell, bleed, and trap food causing increased irritation in your mouth. Oral infections such as gum disease are associated with preterm birth and other complications.
The retail cost for oral exams and prophylaxis (cleaning) is approximately $250 annually.
Fourth Quarter Due Dates
Enrollment period rules for Obamacare plans cause problems for women expecting to deliver in the 4th quarter of any year.
- Uninsured parents are unable to purchase new coverage and may have to foot an estimated $2,000 prenatal care plus her $10,000 to $15,000 uncomplicated delivery expenses on their own.
- Already insured parents are unable to switch to a new plan that includes important providers such as an in-network gynecologist, perinatal specialists, and the hospital where her baby will stay.
- Level 1: well baby nursery
- Level 2: special care nursery
- Level 3: neonatal intensive care
- Level 4: regional intensive care
Annual open enrollments during November and December address coverage beginning in January of February of the next year only. This means that approximately 25% of expectant women ineligible for Medicaid cannot buy or change plans. For example, simple 9-month timing rules many out.
Qualifying life events enable a small portion of the sub-group to enroll anytime. The eligible reasons for a Special Enrollment Period (SEP) include the following within 60 days of the event. Note that becoming pregnant is not on the list. (3)
- Loss of previous health insurance plan
- Had a baby, adopted a child, or placed a child in foster care
- Getting married
Couples with employer-based health benefits face similar challenges based on due date. While most employers schedule their open enrollment in the 4th quarter, many others choose alternative dates.
Calculating the estimated cost of pregnancy complications takes yet another wild turn. In addition to the timing-based lottery noted above, the severity of mom’s complications and the state where she works enter the equation.
Pregnancy complications run the gamut from morning sickness to preeclampsia. However, since most families have medical coverage, the projected out-of-pocket costs are minimal – unless you lost the due date timing lottery.
Lost income due to pregnancy disability affects far more people. Roughly 25% of expectant women experience a medical condition that forces them to stop working before her due date. Most employers do not provide paid leave voluntarily, and most states do not have a requirement.
Five states offer financial help during pregnancy leave via a temporary disability program as of January 2018.
- New Jersey
- New York
- Rhode Island
Washington State will enact a family leave insurance program effective in January of 2020.
Labor and Delivery: Out of Pocket Spending
How much does it cost to have a baby in the hospital in the USA? The actual out-of-pocket costs for labor and delivery in a hospital have a new set of unique twists. The fees are simply too large to matter.
- Parents without insurance cannot pay the bills
- Insurance companies pay most in-network expense for covered members.
- Balance billing for out-of-network services is a huge unknown
Estimating the actual out-of-pocket costs of delivering a baby in a hospital without insurance has a unique wrinkle. The average figures ranging from $10,000 to $15,000 for uncomplicated vaginal or cesarean deliveries rarely apply.
Most families in America live check-to-check and have little money in savings. Therefore, most uninsured patients simply do not have the resources to pay a $10,000 or $15,000 hospital delivery bill. In many cases, one of four things happens over time.
- Charity care reduces the obligation
- Settlement negotiations reduce the amount owed
- Statute of limitations on medical debt expire
- Credit scores drop hurting finances more
The hospital bills skyrocket over $100,000 when the mother or baby experiences complicated labor and delivery. Providers find it even more difficult to collect these enormous sums.
Therefore, uninsured new mothers and fathers rarely pay these bills. The rest of us do with higher premiums.
Projecting the average out-of-pocket costs for labor and delivery in a hospital with insurance requires yet another odd factor. Many people begin by asking the wrong question and miss the biggest exposure.
The plan design determines your financial exposure, rather than the company issuing or managing claims for the policy. Each insurance company offers a broad array of healthcare plans that each has different cost-sharing features.
- A deductible is the amount the patient pays out-of-pocket before benefits begin
- Co-insurance is a percentage the member pays after satisfying the deductible
- Annual maximum is the cost-share limit for individuals and families in the plan
Look at the plan design when estimating leftover hospital delivery expenses from public insurance options such as Medicaid, Obamacare, or Tricare.
The same holds true for private plans issued by Aetna, Blue Cross, or Kaiser. However, there is an extra twist. These private companies also manage claims for Medicaid and Obamacare in most regions. Focus on the deductible, co-insurance, and annual maximum rather than the umbrella name
Out-of-network balance billing is often the biggest uncontained cost of having a baby in the hospital with insurance. The financial impact of delivery in a private versus public hospital is minor compared to new parents’ exposure to balance bills.
Out-of-network providers do not treat the insurance company’s “allowed amount” as payment in full for a medical service. The allowed amount is the volume discount rate that only in-network providers agree to accept as full payment.
Parents frequently check into an in-network hospital only to learn of a huge balance bill after they check out. Hospitals frequently outsource key services unknown to unwary patients. The annual maximum does not apply to balance bills – so patient exposure is unlimited.
These are some common balance billing scenarios.
- Private ambulance to transport a mom in labor
- Anesthesiology groups that administer epidurals
- High-risk perinatal specialists
- Infants transferred to Neonatal Intensive Care Units (NICU)
First Year Newborn Average Cost of Care
The average costs of caring for a newborn baby during its first year of life also defy a broad-brush answer. The outcomes for each family can change based on maternity leave laws in each state, the health of mom and her baby, the choices families make about one-time and ongoing supplies, and whether mom and/or dad intends on returning to work.
Lost income and potential job loss are the most overlooked opportunity costs of caring for an infant in the first year. New mothers need time to recover from labor and delivery and are unable to work. Both parents want to spend time away from the job to bond with their newborn.
The Family Medical Leave Act (FMLA) is the primary maternity leave law in the USA. However, the aftermath for growing families often depends on the laws in the state where mom and or dad work.
The FMLA leave is unpaid.
- The five states mentioned above have mandatory temporary disability programs that replace a portion of income while mom recovers from childbirth. Mothers in the other 45 such as Texas, Florida, Ohio, and Pennsylvania often have nothing.
- Four states have mandatory paid family leave programs that replace a portion of income for both mom and dad to spend time bonding with a newborn (California, New Jersey, New York, and Rhode Island). Washington State joins the fold in 2020.
The FMLA legal job and health care protections cover only about half of the population.
- Small business employees (under 50 employees) do not qualify
- Part-time workers are ineligible (less than 1,250 hours in the last 12 months)
- Newly hired employees lose out (twelve months of tenure)
In addition, the FMLA rights expire after twelve weeks. Women who must stop working prior to delivery can easily exhaust their time allotment. The job loss comes at the most inconvenient time.
However, many states extend the time or expand the eligibility of workplace legal protections.
- Massachusetts expands eligibility to small businesses with 8 or more employees
- Oregon enlarges eligibility and extends the unpaid legal protections to up to 36 weeks
- Connecticut extends the time off to 16 weeks within 24 months
Medical expenses for the mother and her newborn(s) during the first year after birth also have a wide range of outcomes. Each new family member brings a unique set of experiences.
Both mother and baby may have to deal with medical problems that require extra doctor visits and more.
The cost of a new mother’s postnatal care depends primarily on her health. Routine postpartum follow up after discharge from the hospital is not a major budget consideration for most families.
However, many postpartum mothers suffer physical abnormalities that require several follow up visits with a gynecologist. The main disorders that might affect a woman include the following.
- After a vaginal delivery: fissures, infections, and postpartum hemorrhage.
- After a C-section surgery: blood clots in your legs or lungs, anesthesia-related nausea, and bowel movement problems (ileus).
Postpartum depression is more common. New moms may find it difficult to be productive at work and they may require care with a licensed therapist.
Roughly 12% of babies require specialized help in a Neonatal Intensive Care Unit. The most frequent reasons driving this need are pre-term delivery, birth injuries, and other sicknesses.
The medical and non-medical expenses during the first year of life are obviously much higher for NICU babies. Parents needing assisted reproductive technologies often conceive multiples (twins and triplets) who often begin life in an incubator. Now we see all the problem areas combine into a perfect storm.
- Balance billing from out-of-network providers
- Lost income for mom and/or dad
- Potential job loss when preemie needs help at home after discharge
- Loan payments for infertility treatments are due
- Debt consolidation lowers payments but adds to the lifetime interest
Year 1 Supplies
The cost of baby supplies during the first year is also very different for each family because most of the items fall into the discretionary spending category. Newborns quickly outgrow many of the needed items making it easy to find used, donated, or second-hand stuff.
This means that families choose to spend money on brand new items such as cribs, carriers, car seats, clothing, etc. However, they cannot buy everything on consignment. Other items may require extra spending of different monthly amounts.
|Disposable diapers – $72 per month||Cloth diapers washed – $19 per month|
|Baby formula – $105 per month||Breastfeeding – $0|
Daycare is the final area where the expenses of caring for a newborn in the first year are different for every family. The National Association of Child Care Resource & Referral Agencies reports that the monthly cost ranges from $300 to $1,564. (4)
However, even this broad range does not capture every variable.
- Stay at home homes spend nothing
- Live in nannies are much pricier
- States offer financial assistance for low-income families
- The IRS childcare tax credit reduces tax obligations
- Dependent care flexible spending accounts help higher-income families
Here is a bottom-line cheat sheet summary of a range of out-of-pocket expenses a new parent might expect when having a baby. Keep in mind that insurance coverage and individual experiences play a big role.
- Trying to Conceive
- First-line Treatments: $5 to $20,000
- In Vitro Fertilization: Up to $50,000 for 3 attempts
- Financing Charges: Perhaps $20,000 in origination fees and interest
- During Pregnancy
- Test & Ultrasounds: $0 at pregnancy resource centers
- Prenatal Care: Up to $2,000 uninsured
- Dental Work: At least $250 for preventive care
- Pregnancy Complications: $5,000 in lost income (one month depending on earnings)
- Delivery in Hospital
- Without Insurance
- $10,000 vaginal
- $15,000 C-section
- $0 patient has no resources
- With Insurance
- $100 copayments
- $5,000 with a high-deductible plan
- $6,600 maximum in-network
- Balance Billing Estimates
- Private ambulance: $500
- Epidural: $1,000
- Specialist: $500
- Without Insurance
- Newborn’s First-year
- Opportunity Costs
- Lost maternity leave income: $5,000 (one month depending on earnings)
- Lost health insurance: unknown
- Job loss after extended leave: unknown
- Medical Expenses
- Postnatal care: nominal
- NICU confinement: all of the above risks
- Baby Supplies: Approximately $10,000 depending on choices
- Daycare Charges: $300 to $1,500 monthly
- Opportunity Costs