By Jennifer Jane, BSN, RN

If you’re pregnant, due in 2026, and picking a plan during open enrollment, the plan you choose can make a huge difference in what you pay for your journey into parenthood.

Studies show that people with commercial insurance still pay thousands of dollars in out of pocket costs for pregnancy, birth, and postpartum care, and many end up in medical debt (1).

Lyvona is here to help parents by making pregnancy and postpartum costs transparent. On Lyvona.com, real parents upload their medical bills, compare prices, ask questions, and get support as they navigate their health care and insurance.

Quick reality check:

• Studies of employer-based insurance plans show the average out-of-pocket maternity costs are around $3,000–$4,500 (1).
  
• One study reported about 60% of pregnant/postpartum women reported healthcare was unaffordable. Nearly 25% said they skipped care because it was too costly (2).

Lyvona wants to make things easier for you to understand, help you make sure your medical bills and fair and accurate, and give you the tools, resources, and support you need to make it happen.

Here are 7 essential insurance questions to ask before you pick a plan:

1. “Are my obgyn or midwife, and hospital in network?”

This sounds obvious and basic, but some insurance plans can be tricky.
For example, your obgyn can be in-network while your hospital may be out-of-network. Or the hospital may be in-network, but the anesthesiologist is not. Be aware and ask questions about the in-network status of all providers so you’re not stuck with unexpected charges.

What to ask the plan:

• Is this specific obgyn or midwife in-network?
• Is this specific hospital in-network for delivery?
• Are there separate networks for the hospital labs, radiology, anesthesia, or the NICU?
• How do I make sure that they are all in-network?

How to check:

1. Use the plan’s online provider directory to find or confirm providers are in-network and call to confirm.
   
2. Ask for the facility name and tax ID to match what’s on your obgyn’s paperwork.
   
3. Document or screenshot what the representative tells you (capture the date, time, name of rep).

How Lyvona helps:
On Lyvona.com, moms share which hospitals and providers were in-network and where they received surprise bills. You can see actual costs for specific states and hospitals.

2. “What will I pay for prenatal visits, labor, and delivery or C-section on each plan?”

Important costs to consider for each plan:

• Deductible — how much you need to pay before your insurance company starts to help cover charges.
  
• Coinsurance — after the deductible is met, you often need to pay coinsurance, which is commonly 20% of the charges, while insurance picks up 80%. Check your plan for their specific percentages.
  
• Out-of-pocket maximum — the most money you will pay in a year for covered services. After your out-of-pocket max is met, insurance covers 100% of charges for the rest of the year.

Why this matters:

• C-sections are thousands of dollars more expensive than vaginal births. 
• Childbirth costs vary widely across the U.S., with parents and insurers in some states paying more than double what they pay in other states for similar services (3).
• In the U.S., roughly half of maternal care is covered under commercial insurance, and half of moms are covered by Medicaid. One study found the average out-of-pocket spending for maternity services in commercial employer plans was around $4,500 (4). 

That’s a lot of money. You want to make sure you’re being billed correctly.

How Lyvona helps:
Part of Lyvona’s mission is to make these costs less mysterious. Real parents upload their actual hospital bills so you can see the realistic costs and ranges, and can check for duplicate charges on your bills.

3. “How does this plan handle out-of-network care and emergencies?”

You can’t plan for complications, but you should have an idea of how emergencies are handled by your insurance company if they arise.

Examples:

• If you need to give birth in or be transferred to a different hospital that is not in your network.
• If the on-call anesthesiologist is out-of-network, even though the hospital is in-network.

Even with the federal No Surprises Act, which was designed to end surprise medical bills for out-of-network costs for care given in circumstances beyond the patient’s control, patients can still get stuck with out-of-network charges. In one study, 1 in 6 commercially insured adults had unexpected out-of-network costs, and over 60% of the affected people worried about how they were going to afford the unanticipated bills (5) (6).

Ask about:

• What is the coverage level for emergency out-of-network services, and how does the plan handle out-of-network providers at in-network hospitals?
  
• Is there a separate out-of-network deductible and out-of-pocket max? (If so, these out-of-network benefits are often at much higher costs than in-network.)

How Lyvona helps:
Because Lyvona communities focus specifically on pregnancy and postpartum costs, you’ll often find stories from parents who received an unexpected bill from an out-of-network specialist and how they negotiated or appealed it. It’s comforting to have a place to go to find answers and suggestions for complicated billing questions.

4. “When does my baby’s insurance coverage start, and what do I have to do?”

This one is huge and easy to miss when you’re a new, sleep-deprived parent.

• In most employer and marketplace plans, your new baby will be covered under your policy as soon as they’re born, as long as you enroll them within the required timeframe — often 30 or 60 days from birth, but sometimes less. Contact your employer’s Human Resources department or your insurance company for your particular requirements (7).
  
• Coverage is typically retroactive to the date of your baby’s birth once you enroll them, but you must add them to your policy before the deadline.

Ask these and any other questions you have and get clear answers:

• What’s the exact deadline to add my baby after birth?
• What do I need to do to add my newborn to my policy? What are the steps? 
• What documents are needed?
• Will my newborn’s coverage start on the date of their birth?
• What happens with the hospital and pediatrician’s bills if I miss the enrollment window?

How Lyvona helps:
Lyvona has sections dedicated to babies’ bills and postpartum costs, where you can see how newborn hospital charges, NICU stays, and pediatrician visits were charged for other families, so you can get an idea of real costs for real families and have a better idea of what to expect.

5. “Can I expect extra charges for labs, anesthesia, or unexpected complications?”

Your hospital bill is not just one bill. It’s a collection of separate charges from different areas or specialists:

• Hospital or facility
• Obstetrician or midwife 
• Anesthesiologist 
• Pediatrician 
• Neonatologist
• Lab 
• Radiology 
• Pharmacy
• Monitoring
• Operating room

Research shows that maternity costs have risen over time and that cost-sharing insurance structures (like coinsurance) significantly affect what families need to pay out of pocket (4).

Ask the plan:

• How are anesthesia or epidurals billed, and what will my cost share be?
• Are standard newborn tests, procedures, and injections (hearing screen, bilirubin checks, Vitamin K, eye ointment, Hep B vaccine) bundled with my maternity stay or billed separately?

How Lyvona helps:
On lyvona.com, you can see itemized example bills and what other families were actually charged for epidurals, lab work, tests, and NICU stays. That helps you:

• Spot overbilling on your own bills
• Prepare for your own costs
• Learn how other parents successfully disputed billing errors

6. “Does this plan help postpartum moms with mental health and lactation support?”

Most open enrollment conversations focus on pregnancy and delivery, but the postpartum year is a big deal emotionally and financially.

• Healthcare costs can continue for months after birth during mom’s healing process.
• Many parents report ongoing financial hardship and medical debt related to pregnancy and postpartum care, especially if the mom has health complications (8).
  

Ask the plan:

• What coverage will I have to support my mental health before and after birth?
• Is there a copay for therapy?
• Are virtual visits covered the same as in-person visits?
• Is there a limit to how many mental health visits I can have?
• Are lactation consultants covered? Are both In-home and virtual visits covered?
• Does the plan cover breast pumps? What type do they cover? Will I need to pay anything for it?

• How many postpartum checks are covered? Does this change if I need a C-section or have complications?
  

You should have a plan that respects the postpartum period as much as your pregnancy and birth. This is a vital period for self-care.

How Lyvona helps:
Lyvona’s community is about more than comparing bills and numbers. It is also there for emotional support and guidance while you wade through postpartum bills, postpartum appointments, mental health care, and breastfeeding. 

7. “What if my situation is different next year while I’m pregnant due to a new job, Medicaid eligibility changes, or a new insurance plan?”

Changes like this can add stress that you definitely don’t need during pregnancy. But real life happens, and sometimes:

• You or your partner might change jobs mid-pregnancy.
• Your income might go up or down, which could change your eligibility for Medicaid or marketplace plans.
• You might want to choose different coverage during open enrollment.
• Your pregnancy might straddle two calendar years, meaning you’ll need to pay two deductibles to cover your pregnancy!

Ask each plan:

• If my job changes mid-pregnancy, what happens to my coverage?
• If I qualify for Medicaid while pregnant, can I switch to it? 
• How would switching affect my existing providers?
• If my plan renews at the beginning of the year and I’m due shortly after, how will that affect my deductible and out-of-pocket max?

How Lyvona helps:
Lyvona’s tools and community can help you compare real-world costs for different coverage types and learn from people who experienced job changes, switching to or from Medicaid, and mid-pregnancy plan changes.

How to use this list before choosing a plan:

Here’s a simple way to feel confident about your plan choice:

1. Pick 2 or 3 plans that seem to fit your needs from your employer or marketplace, based on premium and coverage.
   
2. Ask the above 7 questions for each plan

• Call member services with questions
• Write down a comparison sheet of details and costs

3. Compare with real bills
   Look on Lyvona.com and look at birth cost examples for your state and hospital type. See how your plan’s details compare.
   
4. Factor in the mental stress of it all
   Sometimes the least expensive plan is not worth the stress if the network is narrow and in-network providers near you are hard to find. You’re not just buying health insurance coverage, you’re buying peace of mind during one of the most important times of your life.

You don’t need to be an insurance expert to make the smart choice for your family. You simply need clear information and a community that can support you and help answer questions. That’s why Lyvona exists — to give parents information and tools for fewer surprises and more control over their health care.

Sources:

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC8276589/ 
2. https://ihpi.umich.edu/news-events/news/study-financial-hardship-prevalent-during-and-after-pregnancy 
3. https://healthcostinstitute.org/all-hcci-reports/understanding-variation-in-spending-on-childbirth-among-the-commercially-insured/ 
4. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00296 
5. https://www.ajmc.com/view/congress-ends-surprise-billing-implications-for-payers-providers-and-patients 
6. https://www.ajronline.org/doi/10.2214/AJR.23.30687 
7. https://www.dol.gov/node/63379