Here’s why people are paying more to get pregnancy care than ever before

Hint: It has to do with the rising cost of health insurance.

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Amid discussions about affordable healthcare, a new study from the Massachusetts Health Policy Commission (HPC) looked at why individuals have begun paying more and more for pregnancy care over the last few years.

What the HPC found is that the problem lies not with increases in the cost of care itself, but in ballooning out-of-pocket spending through deductibles.

What this means is that individuals are paying for a higher proportion of the cost of pregnancy than they did in the past, and the reason is high-deductible health insurance plans.

The study came to these conclusions by looking at out-of-pocket (OOP) spending for healthcare related to all parts of the pregnancy process, from conception to post-partum care, for people in Massachusetts.


OOP spending is the portion of healthcare costs paid for by individuals. This includes deductibles, copays, and coinsurance, which are paid for by the patient.

The HPC used commercial health insurance cost data from 2016 to 2018 to evaluate OOP spending for those years.

What the HPC found is that deductible spending makes up the large majority, or 65%, of OOP costs associated with pregnancy and birth, and that it’s been growing over the past few years.

While the average cost of pregnancy and birth has also risen, from $21,070 in 2016 to $22,000 in 2018, the HPC found that patients are paying for a larger share of those costs.

Average OOP costs increased from 5.3% of the total cost of pregnancy and birth in 2016 to 6.3% of the total cost in 2018. This caused the average OOP cost of pregnancy and birth to rise from $1,119 2016 to $1,372 in 2018.

But within OOP costs, it is deductible spending that is ballooning. From 2016 to 2018, mean spending on deductibles for pregnancy and birth costs increased by 25%, the HPC found.

“Deductibles not only are the largest piece, but they’re by far growing the most quickly,” senior researcher Sasha Albert said. “Copays and coinsurance did increase over these three years, but not by as much.”

The reason deductible spending is increasing, the HPC found, is due to more people enrolling in healthcare plans with high deductibles, which cost less money per month, but allow for more OOP costs before your insurance covers healthcare costs.


As of 2022, the IRS defines a high deductible health insurance plan as any health insurance plan with a deductible of at least $1,400 for an individual or $2,800 for a family.

As of 2019, 85% of commercially-insured Massachusetts residents with non-group coverage, and over 60% of commercially-insured residents employed at small- and medium-sized companies had health insurance plans with high deductibles, the HPC said.

“The population in general who is having babies is more likely to be younger and healthier and not have used up as much of their deductibles in a given year on other costs. So a lot of it will end up being spent on [pregnancy and birth],” Albert said.

The HPC also found that the strongest indicator of how much a patient paid in OOP costs for pregnancy and birth was the size of their employer, which further indicates that the uptick in costs is largely being driven by the structure of insurance plans.

In 2018, the HPC found, patients with non-group coverage paid $2,385 in average OOP costs, while patients working at small firms of 1-50 employees had average OOP costs of $2,007, and patients working at large companies employing 500 people or more paid only $914 on average in OOP costs.

Additionally, the HPC found, OOP costs increased more dramatically between 2016 and 2018 for patients with non-group coverage and for those working at smaller companies.


While OOP costs increased by 41% on average during that two-year period for people with non-group coverage, people working at companies with up to 500 people saw their OOP costs increase about 29% on average, and people working at large companies of 500 people or more only had their OOP costs increase 12%.

Deductible spending was also greatest among patients with non-group coverage and patients employed at small firms, the HPC found, reflecting higher rates of high deductible health insurance plans among these patients. 


“As insurance coverage has gotten more expensive in Massachusetts, both for individual patients and for smaller employers, more employers and more employees are choosing plans that…have larger deductibles in an effort to keep down the total cost of just having insurance,” Albert said.

These increasing costs have an outsized impact on low-income residents who want to have children. On top of other costs associated with having babies, such as baby supplies and babysitters, the cost of pregnancy and birth alone can amount to nearly 3% of the annual income of low-income households, the HPC found.

When patients can’t afford care, they often simply forgo it, the HPC said in its report. This has an even greater impact on Hispanic and Black non-Hispanic families, which have reported having trouble paying for healthcare at higher rates than white non-Hispanic families.

While the HPC said it has recommended families use lower-cost doctors and hospitals more often, such as certified nurse midwives and birth centers, their findings in this new report suggest that that may not be enough to keep pregnancy and birth affordable.


The biggest way to keep giving birth from being an undue financial burden, it said, is to change the structure of insurance plans to avoid high deductibles.


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