Midwife Insurance: Does Insurance Cover a Midwife?

does insurance cover midwife

Does Insurance Cover Midwife Services

With midwifery care on the rise in the United States, people are starting to hear about midwives and home birth. In other countries with similar GDPs, home birth and care with midwives is significantly more prevalent than in the United States; however, we are beginning to catch up. As midwife services gain popularity, it makes sense that people have started to ask whether insurance covers midwife services. The answer is a little bit convoluted, but bear with us as we discuss all the ins and outs! If ever you have questions, please schedule a free one-hour consultation with us to discuss your particular options with our practice. We are happy to answer any questions you have about insurance coverage of midwifery services, and any other questions you might have. 

The shortest answer to the question, “Does insurance cover midwife services?” Is- yes. Some insurance covers midwife services as in-network providers. Usually, this means that the practice has an affiliation with a hospital, although there are rare in-network providers who practice at home. Our practice bills insurance and we are out-of-network providers. People with private insurance usually have two groupings of coverage on their plan: in-network and out-of-network. Insurance coverage varies from plan to plan, but the basics are that each plan has both a deductible (the amount you have to pay before insurance starts covering things) and a percentage reimbursed (what percentage the company pays) for both in-network and out-of-network coverage. People should look at their plan to see if they have out-of-network coverage, as some of the less expensive plans do not have out-of-network coverage. However, many do have out-of-network coverage, and therefore insurance covers midwife services. 

Our global fee is usually less than people’s insurance deductibles for both in- and out- of network plans, meaning that in effect clients pay less for the entirety of midwifery care than they would pay for an in-network hospital birth. For example, if your in-network deductible is $7,000 (a typical deductible amount), you will pay more out of pocket for a hospital birth than you will for a home birth. 

Typically, the entire global fee (which means one fee for all of midwifery care) for prenatal appointments, 24-7 on-call availability from a midwife you know and have relationship with, your birth, and ongoing postpartum care for both the birthing person and the baby is less than the cost of an uncomplicated, intervention-free vaginal birth in the hospital, not including prenatal and postpartum care. 

What Plans Offer Midwife Insurance

The best time to find out if a particular insurance covers midwife services is when that plan is being selected. It is advisable to contact the insurance plan and ask directly if that insurance covers midwifery care. Each person can then select a plan that covers the services they think they will want, including alternative care and midwifery care. In general, reimbursement is seen from Blue Cross plans, Providence plans, and United plans. In Portland, people with Kaiser do not receive insurance coverage for midwife services unless they are planning a hospital birth with Certified Nurse Midwives within the Kaiser system. For those who have specific questions regarding whether their insurance covers midwife services, we encourage everyone to get in touch with us to discuss the specifics of their plan. 

How Much Does a Midwife Cost Without Insurance

Our global fee is a set fee that we discuss with everyone at their consultation. We make arrangements for people based on need, so we ask that everyone get in touch if they want midwifery care and think that cost may be a barrier. As a review of the current insurance coverage for midwife services, consider the following: the national median cost of hospital birth in the United States is $13,524 for the last available data. Women delivering in a hospital setting in the United States can expect to pay out-of-pocket about $3,500 for the birth alone and about $8,800 for prenatal care, hospital delivery, and postpartum care. If there are interventions in the hospital setting or have a Cesarean (which happens about 31%) of the time, the costs go up even more. 

Due to these statistics (which are further discussed in our blog “Let’s Talk about Money” from March 2019) many people will pay significantly less for their midwifery care than they will pay for a hospital birth. A major difference is that people are billed after the fact for their hospital-based care and receive a bill some time in the next year that often comes as a surprise. In midwifery care, people pay up front and then insurance covers the portion of midwife services according to their plan and issue a reimbursement. It works in reverse, and there shouldn’t be any surprises. 

Schedule Your Free Consultation!

Insurance questions, particularly whether insurance covers midwife services, can be really tricky to navigate in the United States because of how our health care is set up. If you want to know if your insurance covers midwife services and if you can afford to have the home birth you’re dreaming of, please schedule a free one-hour consultation with us in our office so we can discuss your individual needs. We offer individualized care to everyone based on their entire picture, and money is no different. Please schedule with us; we want to hear from you!