Under the Affordable Care Act, all major health insurance plans must cover maternity and newborn care as essential health benefits. Understanding your coverage options before and during pregnancy can help you plan for costs and ensure you receive the care you need.
Cost Category | Average Cost (2025) |
Total pregnancy, childbirth, and postpartum (with insurance) | $20,416 total / $2,743 out-of-pocket |
Vaginal delivery (with insurance) | $15,712 total / $2,563 out-of-pocket |
C-section delivery (with insurance) | $28,998 total / $3,071 out-of-pocket |
Vaginal delivery (without insurance) | $13,024–$15,178 (median in-network) |
C-section delivery (without insurance) | $19,292–$22,646 |
Child's first two years (with insurance) | $16,575 total / $1,511 out-of-pocket |
C-section rate (2024) | 32.4% of all U.S. births |
Source: Peterson-KFF Health System Tracker (2021-2023 claims data), FAIR Health (September 2024), CDC (2024 birth data)
Health insurance can significantly reduce your out-of-pocket costs for pregnancy and childbirth. With insurance, families pay an average of $2,743 out-of-pocket for the entire pregnancy and delivery—compared to $18,000+ without insurance.
Pregnancy costs extend well beyond the delivery itself. You'll have 10-15 prenatal visits, lab work, ultrasounds, screenings, and postpartum care—all of which add up quickly without coverage. And while the total cost of a C-section ($28,998) is 85% higher than a vaginal delivery ($15,712), the difference in out-of-pocket costs with insurance is only about 20% ($3,071 vs. $2,563) because many people hit their plan's deductible or out-of-pocket maximum during hospitalization.
Key benefit of insurance: ACA-compliant plans have out-of-pocket maximums ($9,200 for individuals in 2025, $10,600 in 2026) that cap your spending regardless of how much care you need—critical protection if you experience complications or your baby requires NICU care.
Under the Affordable Care Act (ACA), maternity and newborn care is one of 10 essential health benefits that all individual and small group health plans must cover. This protection has been in place since 2014 and ensures that:
Pregnancy cannot be treated as a pre-existing condition
All ACA-compliant plans must cover maternity care (you don't need to buy a separate rider)
No annual or lifetime limits can be placed on maternity coverage
Preventive prenatal services must be covered with no cost-sharing
Important exception: Grandfathered health plans (those that existed before the ACA and haven't significantly changed) and short-term health insurance plans are NOT required to cover maternity care. If you have one of these plans, contact your insurer to understand what pregnancy coverage, if any, is included.
Standard Maternity Benefits (subject to cost-sharing):
Prenatal and postnatal doctor visits
Medications related to your prenatal care
Diagnostic tests, lab work, and screenings
Ultrasounds (number may vary by plan)
Labor and delivery hospitalization
Anesthesia (if needed)
Newborn nursery care
Postpartum care
Preventive Services Covered at No Cost (no copays, coinsurance, or deductible):
Folic acid supplements
Hepatitis B, anemia, and urinary tract infection (UTI) screening
Gestational diabetes screening (typically weeks 24-28)
Rh incompatibility screening and follow-up testing
Tobacco cessation counseling and education
Breastfeeding support, counseling, and equipment (breast pump)
Lactation consultant services
Well-baby and well-child preventive care
Important: You must use in-network providers to receive these benefits at the covered rates. Out-of-network care may not be covered or may result in significantly higher costs.
Your health insurance plan must provide a Summary of Benefits and Coverage (SBC) document that explains how your plan covers pregnancy and childbirth. Review this document carefully to understand:
Your deductible: How much you pay before insurance kicks in
Copays and coinsurance: Your share of costs after meeting the deductible
Out-of-pocket maximum: The most you'll pay in a year (capped at $9,200 individual / $18,400 family in 2025; $10,600 / $21,200 in 2026)
Network requirements: Which hospitals, doctors, and birthing centers are covered
Pre-authorization requirements: Whether you need approval before certain services
Referral requirements: Whether you need a referral to see a specialist or a maternal-fetal medicine doctor
When researching plans, consider these factors:
Provider network: Is your preferred OB-GYN, midwife, and hospital in-network? Check network directories carefully.
Prenatal testing coverage: What screenings and tests are covered? How many ultrasounds are included?
Delivery options: Does the plan cover your preferred birth setting? This includes hospital births, birth center births, and home births with a certified nurse-midwife. Coverage for non-traditional deliveries varies significantly by plan.
Hospital amenities: Does coverage include private vs. shared rooms during your hospital stay?
Out-of-pocket maximum: Lower out-of-pocket maximums provide more protection if you have a complicated pregnancy or delivery.
Total cost calculation: Compare total annual costs: (monthly premium × 12) + expected deductible + estimated copays/coinsurance. A plan with higher premiums but lower out-of-pocket costs may save money during a pregnancy year.
If you're pregnant and don't have health insurance, you have several options in North Carolina:
NC Medicaid for Pregnant Women:
North Carolina Medicaid provides coverage for pregnant women with household income up to 201% of the federal poverty level (FPL). For a family of two (you plus the unborn baby), that's approximately $3,500/month or $42,000/year in 2025.
Coverage includes: Prenatal care, labor and delivery, postpartum care, and newborn care.
Postpartum extension: Coverage now continues for 12 months after delivery (expanded from 60 days)
Enroll anytime: You can apply for Medicaid at any time during pregnancy—no open enrollment required.
Automatic newborn coverage: If Medicaid covers you at delivery, your newborn may be eligible for Medicaid up to age one without a separate application
NC Medicaid Expansion (since December 2023):
North Carolina expanded Medicaid in December 2023. Adults ages 19-64 with income up to 138% FPL ($21,597/year for an individual in 2025) now qualify, regardless of pregnancy status. This expansion has enrolled over 450,000 North Carolinians.
ACA Marketplace Plans:
If you don't qualify for Medicaid, you may be able to enroll in an ACA Marketplace plan through HealthCare.gov. Premium tax credits may significantly reduce your monthly costs.
Important: Pregnancy alone is NOT a qualifying life event for a Special Enrollment Period. You cannot enroll in a Marketplace plan mid-year just because you become pregnant. Plan and enroll during Open Enrollment if you're trying to conceive.
Open Enrollment Period: November 1 through January 15 each year
Enroll by December 15 for coverage starting January 1
Enroll by January 15 for coverage beginning February 1
If you're trying to conceive: Enroll in a comprehensive health plan during Open Enrollment before becoming pregnant. This ensures coverage is in place from conception through delivery.
Special Enrollment Periods: Certain life events allow you to enroll outside of Open Enrollment, including: getting married, losing other health coverage, moving to a new state, having a baby (to add the baby to your plan), or gaining access to new coverage options. Note again that becoming pregnant is NOT a qualifying event.
Important 2026 Update: Enhanced premium tax credits that have made Marketplace coverage more affordable are scheduled to expire December 31, 2025. Unless Congress extends them, many enrollees will see significant premium increases for 2026. Review your options carefully during the 2025 Open Enrollment period.
Once your baby is born, you typically have 30-60 days to add them to your health insurance plan. This is a Special Enrollment Period that allows you to update your coverage mid-year.
Contact your insurance company or your employer's HR department promptly after delivery.
Have your baby's birth certificate and Social Security number (when available) read.y
Coverage for the newborn typically starts from the date of birth
Your monthly premium will increase to reflect the added dependent
Choosing the right health insurance when you're planning a pregnancy can save you thousands of dollars and ensure you have access to quality care. A plan that works when you're not pregnant may not be the best choice when you are.
At Health Plans of NC, our licensed agents specialize in helping North Carolina residents find the right coverage for their growing families. We can help you:
Compare maternity coverage across available plans
Calculate your expected out-of-pocket costs for different plan options
Check if your preferred doctors and hospitals are in-network
Determine if you qualify for Medicaid or premium tax credits
Understand how to maximize your prenatal benefits
Our agents have helped thousands of North Carolina families get the right insurance for their needs—and our services are free to you.
Serving Charlotte, Raleigh, Greensboro, Durham, and all North Carolina communities.