By Jennifer Jane, BSN, RN
One day, you’re celebrating a faint line on a pregnancy test, and it feels like the next you’re caught up in the excitement of writing your birth plan and packing your hospital bag. Then an unsettling realization creeps in — “Wait… am I going to have to pay my insurance deductible twice for one pregnancy?”
If your prenatal care begins in one calendar year and you’re due to deliver the following year, it can seem like you’re paying twice for one pregnancy, requiring you to pay two deductibles for the same pregnancy, one for each year you receive care.
A guide like Lyvona.com can be invaluable because it can give you an idea of what your out-of-pocket costs with your insurance plan could look like, depending on the timing of your pregnancy and birth.
How Deductibles Work
Deductibles reset on a schedule chosen by your insurer or employer. In the U.S., most plans operate on a calendar year (January 1–December 31).
A deductible is the amount you must pay before your insurance begins covering non-preventive services. During pregnancy, this usually includes:
• Diagnostic ultrasounds
• Some prenatal labs
• Genetic testing (NIPT, carrier screening)
• Emergency visits
It depends on how your provider codes services, as either preventive care or diagnostic. Routine screenings should be coded as preventive, and no cost to you, without needing to pay toward your deductible. But when your provider codes any test as diagnostic, that’s when the bills pile up. Usually, any non-preventive test or procedure must be paid for out of pocket 100% until you meet your deductible. For some plans, this includes medication. It’s very important to check these details during open enrollment to choose the plan that best fits your medical needs.
For many employer plans, after you meet your deductible, you start paying coinsurance — you pay a percentage of claims (commonly 20%), and your insurance company pays a percentage (commonly 80%), until you hit your out-of-pocket maximum. After that, your insurance company pays for all medical care as long as they consider it medically necessary according to clinical guidelines.
If your pregnancy and prenatal care occur in one year and your baby is due in the next year, any diagnostic tests, procedures, or treatment claims fall under two different plan years—meaning you pay two deductibles for the same pregnancy.
According to a cross-sectional study of Health Care Cost Institute commercial claims of over one million births, commercial health insurance plans with an annual high deductible force patients to pay higher out-of-pocket costs early in the plan year. High-deductible health plans (HDHPs) are increasingly common even as many U.S. households report difficulty affording out-of-pocket medical costs. HDHPs can lead to higher out-of-pocket costs when an episode of care, such as maternity care, occurs across two plan years, because patients need to pay deductibles and out-of-pocket spending for both plan years. This is a widespread issue, as childbirth is the most common reason for an inpatient stay among the commercially insured (1).
Deductibles and co-insurance shift a portion of the cost of care to people using care services. Requiring people to pay out-of-pocket for a large portion of their health care can cause them to think twice about getting the care they need if they struggle to afford their bills (2).
Prenatal and Delivery Claims
Prenatal and delivery care are often billed differently:
Prenatal visits are often billed individually. Commonly, each office visit, ultrasound, test, and lab is processed as its own claim on the date of service. Some providers may bundle routine prenatal care, but still bill separately for some labs and ultrasounds.
Delivery is usually billed as a bundled service that includes labor, delivery, and routine postpartum care.
So, you may meet your deductible one year from prenatal ultrasounds, tests, and labs not considered routine preventive care, and then need to meet a new deductible in the next year for your delivery.
Even though it may feel like you’re being charged twice, it’s because of timing, of two different deductible year cycles—not duplicate billing.
Timing and Out-of-Pocket Costs
A study in The American Journal of Managed Care found that women whose pregnancies spanned two plan years paid an average of 20–30% higher out-of-pocket costs than pregnancies entirely contained within a single plan year (1).
Less than 25% of families with household incomes between 150% and 400% of the federal poverty level say they can afford a typical family deductible of $12,000 in a common high deductible plan (3).
How Lyvona Can Help
Lyvona.com helps to bridge the information gap in a few ways:
1. Scenario Modeling
What if I deliver on December 28th vs January 2nd?
Lyvona lets you plug in your plan details—deductible, coinsurance, out-of-pocket max—and then generates model scenarios that show your potential maternity costs depending on the timing of birth.
You can see and compare estimates for:
• A due date in early January
• An elective induction or scheduled cesarean late December
• An average cost if labor begins spontaneously in the new year
• Out-of-pocket totals with and without a deductible reset
2. Deductible Reset Calculator
The deductible calculator helps visualize how much of your deductible you’ve met, how much remains, and what that means if your delivery happens after your deductible resets on January 1st.
3. Transparent Breakdowns of Prenatal vs. Delivery Charges
Lyvona helps you understand which services hit which year, based on when they occur. If the delivery bundle is billed in January, Lyvona helps you anticipate those charges so you know what to expect and can plan accordingly.
You Can Plan Ahead with Lyvona’s Help
Being armed with a clear understanding of deductibles, co-insurance, out-of-pocket maximums, how claims are billed, and how timing matters can help you plan without panic.
Lyvona’s tools and support turn the confusion into data you can see, understand, and navigate with confidence, helping you to make choices that fit your medical needs and your finances.
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