Birth center cost vs hospital birth cost: what you'll pay

A birth center birth costs less than a hospital birth on average, often by several thousand dollars. An American Association of Birth Centers (AABC) survey of 120 centers put the average total fee at $8,309 ^[1]. For comparison, pregnancy, birth and postpartum care for a vaginal hospital birth averaged $15,712 for people with employer insurance in 2021–2023 ^[2].

What you pay depends on your coverage. If the center is in your plan's network, your share works much like any other covered birth. If it isn't, you may pay most of the fee yourself, which can cost more than your out-of-pocket share of an in-network hospital birth. Medicaid has the strongest evidence of savings: in a federal evaluation, birth center care cost $2,010 less per mother and baby than typical care, from delivery through the baby's first birthday ^[3].

How much does a birth center cost compared with a hospital?

Two cautions before you compare. The birth center average is older and isn't adjusted for inflation, so current quotes will differ. And the groups aren't identical: birth centers care only for low-risk pregnancies and don't perform C-sections ^[4], so some of the hospital's higher average reflects higher-risk births.

The closest like-for-like comparison comes from Medicaid. In the CMS Strong Start evaluation, Medicaid spending during the delivery period averaged $6,527 for birth center participants and $8,286 for a matched comparison group ^[3]. From delivery to the baby's first birthday, it was $10,562 versus $12,572 ^[3]. The evaluators linked the savings partly to fewer C-sections (17.5% versus 29.0%) and partly to lower payment rates for birth center deliveries ^[3].

What does a birth center fee include?

Most centers quote one package price. The AABC estimate combines three parts ^[1]:

• Professional fee: the midwife's prenatal visits, the birth and postpartum visits.
• Facility fee: use of the birth room, equipment and supplies.
• Newborn fee: care for the baby after birth.

Some things are often billed separately. In Washington State's Medicaid program, for example, the birth center facility fee covered room charges, equipment, supplies and pain medication, while lab work, ultrasounds, the newborn hearing screen and other drugs could be billed separately ^[4]. Private-pay packages vary from center to center, so ask for the list of exclusions in writing.

What happens to your bill if you transfer to a hospital?

Plan for it, because transfers are common. In the National Birth Center Study II, which followed 15,574 women at 79 birth centers, 84% gave birth at the center. Another 4% were transferred to a hospital before being admitted to the center, and 12% were transferred during labor ^[5]. Most transfers weren't emergencies: 1.9% of mothers or newborns needed an emergency transfer ^[5].

If you transfer, you'll likely see three kinds of bills:

1. Hospital bills. The hospital's facility charge and the clinicians who care for you there go through your plan's hospital benefits, with the usual deductible and coinsurance.
2. A partial birth center bill. You may still owe the center for prenatal care and the labor care it provided. Medicaid programs have a separate code for this. Washington's paid birth centers a smaller "interim labor" facility fee (code S4005) when a client labored at the center and then transferred to a hospital for delivery ^[4]. Ask your center what it charges, and what it refunds, if you transfer.
3. Ambulance. Ground ambulance generally isn't covered by the No Surprises Act's billing protections, so an out-of-network ambulance can still bill you its own rate ^[6].

If you have insurance, the No Surprises Act protects you from surprise out-of-network bills for emergency care, and for non-emergency care at in-network hospitals, hospital outpatient departments and ambulatory surgical centers ^[6]. Birth centers aren't on that list. Confirm yourself that the center, its midwives and the hospital it transfers to are all in network.

Does insurance or Medicaid cover a birth center?

Medicaid. Federal law makes freestanding birth center services a Medicaid benefit. It defines a birth center as a facility that isn't a hospital and is licensed or otherwise approved by the state to provide prenatal, labor and delivery, or postpartum care ^[7]. States must also pay separately the providers who give that care at the center ^[7].

That doesn't mean every center takes Medicaid. The center has to be in a state that licenses or approves birth centers, and it has to enroll with the program. AABC counted about 400 birth centers in 40 states and DC in February 2022 ^[8], so some states have none. In 2017, Medicaid paid for 17.9% of birth center births, compared with 43.4% of hospital births ^[9].

Private insurance. Many plans cover birth centers, but network status decides what you pay. In 2017, private insurance paid for 47.5% of birth center births, and 32.2% were self-paid ^[9]. A self-paid birth center birth means paying the full package price yourself, so check coverage before your first visit.

A quick way to compare your own numbers. Here's an example with made-up plan terms: a $2,000 deductible, 20% coinsurance and a $5,000 out-of-pocket maximum.

Swap in your plan's deductible, coinsurance and out-of-pocket maximum, and the center's written price. What you pay for covered in-network care stops at your out-of-pocket maximum, so on a plan with a low maximum, the gap between settings shrinks.

For the differences that aren't about money, such as who's eligible and what happens in an emergency, see birth center vs hospital. If you're on Medicaid or think you might qualify, see Medicaid for pregnancy.

How to get a written estimate from a birth center

If you're uninsured or choose not to use insurance, the No Surprises Act gives you the right to a good faith estimate when you schedule care at least 3 business days ahead, and you can ask any provider for one directly ^[10]. If your bill comes in at least $400 over the estimate, you can dispute it within 120 days of getting the bill, and an independent third party will review it ^[10]. Each estimate lists charges from one provider or facility, so request one from the center and from any midwife or lab that bills separately ^[10].

If you're insured, ask the center for the same level of detail anyway, then compare it with your plan's deductible and out-of-pocket maximum. Our guide to the cost of having a baby shows how a hospital bill adds up for comparison. Questions to ask:

• What's the total fee, and how much is professional, facility and newborn care?
• Is there a registration fee or deposit, and is it refundable?
• Which labs, ultrasounds and medications are billed separately, and by whom?
• Are the center, its midwives and its backup hospital in network with my plan?
• What do I owe if I transfer care before labor, during labor or after the birth?
• When are payments due? Do you offer a self-pay discount or a payment plan?
• Do you accept Medicaid?
• Can I have the estimate in writing, signed and dated?

To see what midwife care costs in other settings, read how much a midwife costs. When you're ready to compare centers, start with our birth center directory.