How Much More Does A C-Section Cost Than A Regular Delivery? Here's A Breakdown
In the United States, the costs associated with having a baby are some of the highest anywhere in the world. While many parents spend the 40 weeks before their babies are born planning (with many starting earlier), things don't always go according to those plans. Even if they do, depending on where and how a baby is born, the costs are going to be very different. How much more does a C-section cost than a regular birth? Where you live makes a difference, as do many other factors.
When referring to the cost of a C-section, or any other birth experience, there are really two different figures to consider: how much it costs in total after all the various charges (by the doctor, the hospital, and so on) are added up, and then how much the new parents are responsible for paying after their health insurance has paid its portion (that is, if the parents have health insurance). At hospitals throughout the U.S., providers and facilities might charge different amounts for the same type of service (like use of a hospital room or cost of an epidural). To make things even more complicated, individual insurance companies and even government-funded programs like Medicaid can all decide to pay different amounts for those services.
Data collected and analyzed by Truven Health Analytics in partnership with the National Partnership for Women and Families' Childbirth Connection program looked at reported costs for C-sections and vaginal deliveries throughout states that participated in the Healthcare Cost and Utilization Project, which is a voluntary program administered by the U.S. Agency for Healthcare Research and Quality. Since not all states participated, the data for the entire U.S. is only an average of the states that provided data in 2010 (34 states provided data). But researchers were able to evaluate specific states that had higher than average and lower than average costs for each type of birth. For example, its report found that Maryland had the lowest average cost for all types of birth, and the difference between what hospitals charged for a vaginal delivery versus a C-section was less than $2,000. By contrast, in California, the average difference was upwards of $15,000 between the two procedures, with the C-section being the more expensive option.
That all being said, when it came down to averages, the report found that an uncomplicated vaginal delivery typically cost around $20,000. An uncomplicated C-section costs around $50,000. For patients who had insurance, the average payment by their insurance company for an uncomplicated vaginal delivery was just over $18,200, and just over $27,000 for an uncomplicated C-section. The caveat of "uncomplicated" is important here: complications like the need for surgery or a stay in the NICU can tack on thousands more. According to data collected by the March of Dimes, on average, a 13-day stay in the NICU costs upwards of $76,000. For babies born at less than 32 weeks who require longer stays, the costs can be around or above $200,000.
Again, the costs of labor and delivery versus how much new parents are actually responsible for paying will differ depending on how much was charged in total, and how much their insurance will pay for. According to the report by Childbirth Connection, the average out-of-pocket cost for women with commercial insurance plans were $2,244 for uncomplicated vaginal deliveries and $2,669 for uncomplicated C-sections. Medicaid patients' costs were almost always entirely covered for both uncomplicated vaginal and C-section deliveries.
It hasn't always been this way, though: prior to the Affordable Care Act, maternity costs weren't considered to be "essential health benefits" by all plans. While some insurance companies did provide coverage, they could choose not too. Those that did cover could also choose what they covered for services, and how much, according to the Kaiser Family Foundation. Pregnancy was also considered a pre-existing condition, which meant that if a pregnant woman lost her insurance and needed to switch to a new plan, or had been previously uninsured and needed to acquire insurance to help pay for the costs of her pregnancy, she could be denied coverage by an insurance company or charged more money because she was pregnant.
The Affordable Care Act, however, stipulated that individual and private insurance plans not only had to cover maternity costs as an "essential health benefit," but that insurance companies couldn't discriminate against a woman who was pregnant by charging her more money or denying her coverage. This, combined with the Medicaid expansion in several states, allowed more pregnant women to become insured.
If the ACA is repealed and replaced with a plan that no longer considers maternity costs an essential benefit, allows pregnancy to once again be listed as a pre-existing condition, and removes the Medicaid expansion mandate, not only will many pregnant women lose coverage (and be penalized for trying to get new coverage) but it will also put many women of childbearing age at risk, too.