Paying for a Midwife, Birth Center or Doula: Medicaid, Insurance and HSAs
What Medicaid must cover, what Marketplace plans cover, global fees, doula fees and HSA or FSA rules.
Midwifery and doula care can cost far less than people expect, or be paid in full by insurance or Medicaid, but the rules differ for each kind of provider. This guide sets out what federal law and official sources say, and the questions to ask. It is general information, not insurance, legal or tax advice; confirm coverage with your plan.
Medicaid: nurse-midwives and birth centers are mandatory benefits
Medicaid pays for a large share of births in the U.S., and federal law requires every state Medicaid program to cover two of the services on this site. Medicaid.gov lists "Nurse Midwife services" and "Freestanding birth center services when licensed or otherwise recognized by the state" among the mandatory benefits (Medicaid.gov: mandatory and optional benefits).
The statute is broad for nurse-midwives: Medicaid covers services a nurse-midwife is legally authorized to perform under state law, "whether or not the nurse-midwife is under the supervision of, or associated with, a physician" (42 U.S.C. 1396d(a)(17)). In practice, you still need a midwife or center that is enrolled with your state Medicaid program or your Medicaid managed care plan. Ask before your first visit.
Medicaid: CPMs, licensed midwives and doulas
Coverage of certified professional midwives, licensed midwives and doulas is not on the federal mandatory list, so each state decides. Some states pay licensed midwives for home and birth center births; some cover doula support during pregnancy, labor and postpartum, often with a set number of visits. Ask your state Medicaid agency or your plan whether it covers the provider you want, and ask the provider whether they are enrolled.
Private insurance and Marketplace plans
All Marketplace plans must cover "pregnancy, maternity, and newborn care (both before and after birth)" as one of the ten essential health benefits, along with breastfeeding coverage (HealthCare.gov). That does not mean every midwife or birth center is in network. Ask your plan:
- Does it cover care by a certified nurse-midwife? By a CPM or licensed midwife?
- Does it cover births at a freestanding birth center, and at home?
- Which midwives and birth centers near me are in network? If none, is there an out-of-network benefit?
- Does it cover a doula, and does the doula need an NPI or a certification?
- What is my deductible and out-of-pocket maximum for a birth, and does a hospital transfer count separately?
Get the answers in writing, and keep a note of who you spoke to. If your plan says a midwife or birth center is out of network, ask whether it will make a network exception when no in-network provider offers the same kind of care nearby, and ask the provider whether they can help with that request.
Global fees and what they include
Many midwives and birth centers charge one global fee covering prenatal visits, the birth and postpartum care. Ask exactly what is included: lab work, ultrasounds, newborn exams, home visits, the birth center facility fee, and supplies. Ask what you pay if you transfer to a hospital during labor or move out of their care before the birth, and whether any part of the fee is refundable. Payment plans are common.
Doula fees
Doulas usually charge a package fee for a few prenatal meetings, continuous support in labor and one or more postpartum visits; postpartum doulas often charge by the hour. Ask what is included, whether a backup doula covers if they are unavailable, and the refund policy. Some employers, health plans and community programs offer doula benefits or free doula care; the doula organizations listed here include community-based programs.
If you transfer to a hospital
A transfer during pregnancy or labor usually means a second set of bills: the hospital, a physician, and sometimes an anesthesiologist or a newborn specialist. Ask your plan in advance whether the hospital your midwife or birth center transfers to is in network, and ask the midwife or center how their own fee changes if you transfer. Knowing both answers ahead of time avoids surprises at a stressful moment.
Newborn and postpartum costs
The baby's care is billed separately from yours. Ask who performs the newborn exam and newborn screening tests, and whether they are included in the global fee. Check your plan's deadline for adding a newborn to your coverage, and do it promptly. For feeding support, HealthCare.gov lists breastfeeding coverage among the benefits Marketplace plans must include (HealthCare.gov); ask whether a lactation consultant in your midwife's practice is covered.
HSA and FSA accounts
IRS Publication 502 defines medical expenses as "the costs of diagnosis, cure, mitigation, treatment, or prevention of disease and for the purpose of affecting any part or function of the body." It specifically lists pregnancy test kits and breast pumps and supplies that assist lactation (IRS Publication 502). Midwifery and birth center care generally meets the general definition. The publication does not mention doulas; ask your plan administrator or a tax professional before paying a doula from an HSA or FSA, and keep itemized receipts for everything.
Questions to ask every provider about cost
- What is your total fee, and what does it cover?
- Which insurance plans and Medicaid plans do you accept? Will you bill my plan, or give me a receipt to submit?
- What happens to the fee if I transfer to a hospital or to another provider?
- Do you offer a payment plan or a sliding scale?
- Can you give me a receipt that shows your license number and NPI?
Every listing on this site shows the provider's NPI and, where the provider entered one, a license number, with a link to the official record (NPPES).
General information only, current as of the date above. The information on Midwife & Birth Center Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Rules and programs change; check the official sources linked in this guide.