Out-of-pocket spending on maternity care on the rise, study finds

Out-of-pocket costs related to maternity care grew significantly over the past decade—despite an Affordable Care Act (ACA) mandate that such services be covered, a new study shows. 

Researchers led by a team at Michigan Medicine examined data on a group of 657,051 with employer-sponsored coverage and found for those with out-of-pocket costs associated with maternity care average spending increased from $3,069 in 2008 to $4,569 in 2015. 

The study, which was published in Health Affairs, found that out-of-pocket spending associated with cesarean section births increased from $3,364 to $5,161 in that same window, while costs associated with vaginal births went up from $2,910 to $4,314. 

What’s behind that trend? The ACA mandates that insurers cover maternity services, but health plans have few restrictions on how they apply co-payments, deductibles and other cost-sharing to maternity care. 

RELATED: Humana dives into value-based care for maternity health 

“We were surprised to learn that the vast majority of women paid for critical health services tied to having a baby,” Michelle Moniz, M.D., an OB-GYN at Michigan Medicine and the study’s lead author, said in a statement. “These are not small co-pays. The costs are staggering.” 

In addition, the study found that women are also paying for a greater share of the total cost for their maternity care. For a vaginal birth, women paid 21% of the costs themselves in 2015, up from 13% in 2008. 

For C-sections, women shouldered 15% of expenses in 2015, an increase from 10% in 2008. 

As childbirth is the top reason for American women to be hospitalized, there are clear benefits to health plans in promoting greater value in maternity care, the researchers said. States and the feds should also consider enacting policies that impose limitations on cost-sharing for maternity care, they said. 

High out-of-pocket costs can lead some patients to skip needed care, which could be harmful for both an expectant mother and a newborn, Moniz said. 

“Maternity and childbirth are essential health services that promote the well-being of families across our country,” Moniz said. “Reducing patients’ costs for these high-value services makes sense.”