(Oona Zenda\/KFF Health News)<\/p>\n
As Grace Griffin and her husband were welcoming their long-awaited baby \u2014 a daughter \u2014 Griffin found herself worried about looming medical bills and unsure if their family could pay for the care they needed.<\/p>\n
\u201cThis whole experience has me wondering (keeping me up at night, actually): Can we ever afford to have another child?\u201d<\/em><\/p>\n \u2014 Grace Griffin, Calumet, Michigan<\/strong><\/p>\n Grace and Daniel Griffin, both 26, knew money would be tight once they had their first child. So, even before the Calumet, Michigan, couple tried to conceive, they began crunching the numbers to figure out the cost of pregnancy.<\/p>\n \u201cWe wanted to save up enough to pay for those medical bills right away, if possible,\u201d Grace said.<\/p>\n But the cost estimator she found linked to her UnitedHealthcare student plan asked for medical billing codes for each procedure Grace was likely to receive. That\u2019s information she didn\u2019t have.<\/p>\n So, she kept digging until she found the Summary of Benefits and Coverage information<\/a> on the health plan\u2019s website, which estimated out-of-pocket costs for a routine pregnancy and delivery at about $2,700.<\/p>\n \u201cWe thought, \u2018OK, that\u2019s doable,\u2019\u201d she said. \u201cWe should be able to save up that much and pay for that out-of-pocket.\u201d<\/p>\n But, as the expenses piled up, it was clear the estimate wasn\u2019t even close.<\/p>\n 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. That meant that for every $100 billed for things like routine blood work and other needed care, she was on the hook for $20.<\/p>\n \u201cWhen I started getting lab work is when we started realizing expenses would add up quickly,\u201d Grace said. Routine blood tests to check iron levels or for gestational diabetes were a couple of hundred dollars every visit, she said.<\/p>\n In June, after what Grace described as a routine pregnancy and delivery, the couple welcomed their daughter. Then the Griffins received an \u201cexplanation of benefits\u201d notice, which showed the hospital charged about $18,000 for the delivery, with the family on the hook for a sizable portion.<\/p>\n \u201cI thought, \u2018Oh no, it\u2019s going to be a lot,\u2019\u201d she said. \u201cMuch more than we budgeted for.\u201d<\/p>\n She was right.<\/p>\n In early October, Grace said, her family\u2019s out-of-pocket expenses totaled more than $9,000, more than three times the general estimate published by her insurer for pregnancy-related costs.<\/p>\n Meanwhile, Grace and Daniel are scrambling to cover their bills.<\/p>\n For years, federal lawmakers have tried to remedy this issue, said Sabrina Corlette<\/a>, a research professor and co-director of Georgetown University\u2019s Center on Health Insurance Reforms. To make healthcare costs more transparent and accessible to patients, Congress required insurers to provide consumers with an individualized \u201cadvanced explanation of benefits\u201d 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<\/a>.<\/p>\n \u201cSo, it\u2019s basically 4\u00bd years since this was supposed to be available, and I think it\u2019s a source of a lot of frustration for a lot of folks,\u201d Corlette said. \u201cPeople have a right under the law to know these things.\u201d<\/p>\n Meanwhile, she said, another change<\/a> is pending. Beginning Jan. 1, 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.<\/p>\n The change could make it easier to see what individual services cost, but Corlette said it\u2019s not yet clear whether the change will make it easier for people trying to stick to a budget.<\/p>\n \u201cI could see where it might be advantageous to the provider,\u201d she said. \u201cBut I\u2019m not sure I\u2019m seeing benefits to the patient.\u201d<\/p>\n Until out-of-pocket maternity expenses get easier to estimate, here are some tips to help you budget for the cost of pregnancy.<\/p>\n 1. <\/strong>Enroll your baby before the clock runs out.<\/strong><\/p>\n Ensuring your newborn has health coverage is one of the first paperwork responsibilities parents face in the whirlwind of bringing a baby home.<\/p>\n Birth creates what\u2019s known as a special enrollment opportunity, meaning you don\u2019t have to wait until the annual open enrollment period to sign up a newborn.<\/p>\n Many employer health plans require parents to request enrollment within 30 days of birth. Marketplace plans \u2014 for those who buy their own insurance rather than get it from an employer or the government \u2014 generally allow 60 days. Wait too long, and your baby may be left uninsured until the following year.<\/p>\n Michelle Critzer of Ventura, California, 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 2026, and Critzer missed the enrollment deadline for him. Ever since, she\u2019s been asking her insurer to make an exception \u2014 so far, without success.<\/p>\n \u201cThe way they set hard must-dos within 30 days of having a baby is actually insanity,\u201d she said.<\/p>\n The family was able to enroll Hudson in a health plan through Critzer\u2019s husband\u2019s workplace, which has a 60-day enrollment window. But that coverage is not nearly as robust as Critzer\u2019s insurance, she said. Still, she\u2019s grateful to have Hudson insured while she continues pressing her own plan to enroll him.<\/p>\n 2. <\/strong>Ask about must-know numbers, like your MOOP.<\/strong><\/p>\n Budgeting for a pregnancy often begins with a tally of the expected expenses. The deductible is the amount you\u2019ll pay before much of your insurance coverage kicks in.<\/p>\n After that, you\u2019ll likely face copayments \u2014 fixed fees paid each time you receive service, regardless of the size of the bill.<\/p>\n 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.<\/p>\n MOOP, or \u201cmaximum out-of-pocket\u201d expense, is another must-know number. Your plan\u2019s MOOP is the ceiling on what you\u2019ll pay each year for covered, in-network services (care that your health plan has contracted to pay at negotiated, lower rates).<\/p>\n 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<\/a>. Your plan might set a lower maximum, but once your spending reaches your plan\u2019s limit, insurance pays 100% of all further in-network costs for that year.<\/p>\n One complication to be aware of: If your pregnancy overlaps two plan years, the maximum 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.<\/p>\n 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\u2019s more incentive to meticulously seek out in-network care.<\/p>\n As a family, the Griffins had a $18,000 MOOP, and Grace\u2019s individual maximum was $9,000.<\/p>\n 3. <\/strong>Choose in-network care, when you can.<\/strong><\/p>\n You picked an obstetrician in your plan, but don\u2019t assume others on the care team are in-network providers.<\/p>\n Ask about the hospital, labs, and imaging facilities your doctor\u2019s office may use. Corlette suggested that patients explicitly tell the doctor\u2019s office to send tests to an in-network provider.<\/p>\n Federal law<\/a> protects patients who go to an in-network hospital or other in-network facility from out-of-network \u201csurprise bills\u201d issued by out-of-network providers.<\/p>\n 4. <\/strong>Check every bill \u2014 and don\u2019t be afraid to file an appeal.<\/strong><\/p>\n 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.<\/p>\n Still, these costs sometimes get mistakenly passed on to the patient.<\/p>\n To protect against billing errors, Corlette suggests patients become familiar with these pregnancy-related services<\/a>, and then check every bill.<\/p>\n If your insurer refuses to pay for a covered charge, consider filing an appeal.<\/p>\n 5. <\/strong>Seek help before the bills pile up.<\/strong><\/p>\n Most hospitals offer financial assistance programs. Find out if 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.<\/p>\n Corlette said to make sure any arrangement is formally agreed upon in advance so the account isn\u2019t unexpectedly turned over to collections.<\/p>\n Also investigate other assistance.<\/p>\n Grace Griffin qualified for Michigan\u2019s Rx Kids program<\/a>, which provides eligible families in certain communities with $1,500 during pregnancy and $500 a month for the baby\u2019s first six months or year of life.<\/p>\n That money has helped keep the medical bills from devouring the Griffins\u2019 emergency savings.<\/p>\n \u201cIt takes a lot of pressure off,\u201d she said.<\/p>\n Healthcare Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. <\/em>Share your story<\/em><\/a>. The crowdsourced project is a joint production of NPR and KFF Health News.<\/em><\/p>\n<\/div>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" (Oona Zenda\/KFF Health News) As Grace Griffin and her husband were welcoming their long-awaited baby \u2014 a daughter \u2014 Griffin found herself worried about looming medical bills and unsure if their family could pay for the care they needed. \u201cThis whole experience has me wondering (keeping me up at night, actually): Can we ever afford…<\/p>\n","protected":false},"author":0,"featured_media":16480,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-16479","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16479"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16479"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16479\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/16480"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16479"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16479"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16479"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}