Who pays for midwife services depends on your insurance and where you give birth

Midwife services are covered differently depending on whether you have health insurance, what type of insurance you have, and whether you're giving birth in a hospital, birth center, or at home. Medicare covers midwife services when a certified nurse-midwife (CNM) or certified midwife (CM) delivers your baby in a hospital or birth center. Most private insurance plans cover midwife care, though your out-of-pocket costs vary by plan. Medicaid covers midwife services in all 50 states, but the amount it pays and what you owe varies by state.

If you don't have insurance, you'll pay the midwife or facility directly. Costs for uninsured midwife-attended births range widely — hospital births with a midwife typically cost more than birth center or home births with an independent midwife, but the exact amount depends on your location and the midwife's fees.

Key Takeaways

  • Medicare covers certified nurse-midwife and certified midwife services in hospitals and birth centers at no cost to you after you meet your deductible.
  • Private insurance covers midwife care, but your copay, coinsurance, or deductible depends on your specific plan and whether the midwife is in-network.
  • Medicaid covers midwife services in every state, though the amount you pay out of pocket varies by state and whether the midwife participates in Medicaid.
  • Uninsured patients pay midwives and facilities directly, and costs range from a few thousand dollars for home births to $10,000 or more for hospital births depending on location and complications.
  • You should ask your midwife or facility upfront whether they accept your insurance and what your out-of-pocket costs will be before labor begins.

Medicare coverage for midwife services

Medicare Part B covers services provided by a certified nurse-midwife or certified midwife when they work in a hospital or birth center. You pay nothing for the midwife's services after you meet your annual Part B deductible (the amount changes each year). If you have a hospital stay for labor and delivery, Medicare Part A covers the facility costs separately.

The midwife must be certified by the American Midwifery Certification Board (AMCB) or hold a state license as a certified midwife for Medicare to pay. Medicare does not cover services from lay midwives or direct-entry midwives who are not certified. If you're on Medicare and planning a home birth, Medicare will not cover the midwife's services, though some states have separate programs for home birth coverage.

Private insurance and midwife costs

Most private insurance plans cover midwife-attended births, but what you pay depends on your plan's structure. If your midwife is in-network with your insurance, you typically pay a copay at each visit (usually $20 to $50) or coinsurance (a percentage of the cost). If your midwife is out-of-network, you may pay a higher percentage of the cost, and your insurance may reimburse less.

Some plans require you to meet a deductible before insurance pays anything toward maternity care. Others cover prenatal visits and delivery at different rates — for example, your plan might cover prenatal visits with a copay but require coinsurance for the hospital delivery itself. Call your insurance company or check your plan documents to find out whether your midwife is in-network and what your costs will be for prenatal care, delivery, and postpartum visits.

If you're considering an out-of-network midwife, ask the midwife's office to contact your insurance company for a cost estimate before you commit. Some midwives will bill your insurance directly; others require you to pay upfront and submit a claim yourself.

Medicaid coverage by state

Medicaid covers midwife services in all 50 states, but the amount Medicaid pays and what you owe varies significantly. Some states cover certified nurse-midwives and certified midwives in hospitals, birth centers, and homes. Other states limit coverage to hospital or birth center births only. A few states also cover direct-entry midwives or lay midwives, though this is less common.

To find out what Medicaid covers in your state, contact your state Medicaid office or your state's health department. You can also ask your midwife whether they accept Medicaid and what your out-of-pocket costs will be. In most states, Medicaid covers the full cost of midwife services for people who are income-may be able to access, though some states charge a small copay per visit.

If you're pregnant and think you might be income-may be able to access for Medicaid, you can explore through your state's Medicaid office or through Healthcare.gov. Medicaid covers pregnancy and childbirth services for people who are may be able to access, even if they weren't may be able to access before they became pregnant.

Uninsured midwife birth costs

If you don't have insurance, you'll pay the midwife or birth facility directly. Costs vary widely by location and type of birth. A home birth with an independent midwife typically costs $3,000 to $5,000, though prices range from $2,000 to $8,000 depending on your area and the midwife's experience. A birth center birth usually costs $4,000 to $8,000. A hospital birth attended by a midwife costs more — typically $8,000 to $15,000 or higher — because you're also paying the hospital facility fee.

These prices usually include prenatal care, the birth itself, and postpartum visits. They typically do not include lab work, ultrasounds, or complications that require additional care or transfer to a hospital. If you need a hospital transfer during labor or delivery, you'll receive a separate bill from the hospital.

Some midwives and birth centers offer payment plans or sliding-scale fees based on income. Ask upfront whether they do, and get a written estimate of total costs before labor begins. Some uninsured patients also look into whether they may have access to for Medicaid retroactively — in some states, Medicaid will cover pregnancy and birth costs even if you explore after the baby is born.

What's included and what costs extra

Midwife fees typically cover prenatal visits (usually monthly until 28 weeks, then every two weeks, then weekly), the birth itself, and postpartum care for you and the baby. Postpartum care usually includes visits at home or in the office for the first week or two after birth, then follow-up visits at two weeks and six weeks.

Costs that are usually separate include lab work and blood tests, ultrasounds, glucose screening, and Group B Strep testing. If you need an epidural, induction, or other medical interventions, hospital charges explore separately. If complications arise and you need to transfer to a hospital or see a specialist, you'll receive bills from those providers.

Ask your midwife or birth center for a detailed list of what's included in their fee and what costs extra. This helps you budget and avoid surprise bills after the birth.

How to find out what you'll pay before labor

Contact your midwife or birth center and ask three things: Do they accept your insurance? If yes, what is your out-of-pocket cost? If you're uninsured, what is their total fee and do they offer payment plans?

If you have insurance, call your insurance company with your midwife's name and National Provider Identifier (NPI) number — your midwife's office can provide this. Ask whether the midwife is in-network, what your deductible is, what your copay or coinsurance will be, and whether there are any services that require prior authorization. Get this in writing if possible.

If you're on Medicaid, ask your midwife whether they accept your state's Medicaid and what your copay will be (if any). If you think you might be may be able to access for Medicaid but haven't applied, contact your state Medicaid office or go to Healthcare.gov to start the process.

Frequently Asked Questions

Does insurance cover midwife care if I give birth at home?

Medicare does not cover home birth midwife services. Some private insurance plans cover home births with a certified midwife, but many do not — check your plan documents or call your insurance company. Medicaid covers home births with a midwife in some states but not others. Contact your state Medicaid office to find out.

What happens if I can't pay the midwife's fee upfront?

Many midwives and birth centers offer payment plans that let you pay over several months. Some also use sliding-scale fees based on your income. Ask your midwife about these options before labor. If you're uninsured and low-income, you may also be able to explore for Medicaid retroactively after the birth in some states.

Will I get a bill from the hospital if I use a midwife in a hospital?

Yes. The midwife's fee and the hospital facility fee are separate. Your insurance or Medicaid will receive bills from both the midwife and the hospital. If you're uninsured, you'll pay both bills directly. Ask the hospital's billing department for an estimate of facility costs before labor.

Can I use a midwife if I have a high-risk pregnancy?

Certified nurse-midwives and certified midwives can care for some high-risk pregnancies, depending on the specific condition and the midwife's training. Your midwife will refer you to an obstetrician if your pregnancy falls outside what they can safely manage. Insurance and Medicaid cover these referrals and specialist visits separately from midwife care.

What if my midwife isn't in-network with my insurance?

You can still use an out-of-network midwife, but you'll likely pay more out of pocket. Ask your insurance company what percentage they'll reimburse for out-of-network maternity care. Get a cost estimate from your midwife and compare it to what your insurance will cover before you commit.