Most insurance plans do cover home birth with a licensed midwife, but the amount they reimburse varies significantly. You'll likely need to pay your midwife upfront and submit claims yourself, and out-of-network plans typically reimburse 50-80% of the total fee. Medicaid covers home birth in most states, but finding a midwife who accepts it directly can be difficult.
You can research birth preferences all you want, but if you can't figure out whether insurance will cover it, you're stuck. This article breaks down exactly what different insurance types pay for home birth, what you'll pay out of pocket, and how reimbursement actually works when your midwife isn't in-network.
Insurance plans that cover midwifery services cover the same things whether you birth at home or in a hospital: prenatal visits, the birth itself, and postpartum care. This bundle is called global maternity care. Most plans cover home birth supplies like the birth kit, though some classify these as separate durable medical goods.
The catch is that most home birth midwives don't contract with insurance companies as in-network providers. This means you pay your midwife directly (usually $3,500-$6,500 total) and then submit a claim to your insurance for reimbursement. You're using out-of-network benefits, which typically reimburse 50-80% after you meet your out-of-network deductible.
Some midwives do contract with specific insurance plans or Medicaid. If your midwife is in-network, you'll pay your standard copay or coinsurance instead of the full fee upfront. About 15-20% of home birth midwives accept insurance directly, and this varies widely by region.
The amount you get back depends on your plan's out-of-network reimbursement rate and how your midwife bills. Here's what families typically see in practice.
If your plan reimburses at 70% of the billed amount and your midwife charges $5,000, you'd receive $3,500 back after meeting your deductible. But many plans reimburse based on "usual and customary" rates, which are often lower than what midwives charge. If your insurance decides the usual rate is $4,000, you'll get 70% of that ($2,800), not 70% of $5,000.
Some families get 80-90% back. Others get 40% or are denied entirely because their plan excludes out-of-network maternity care. You won't know your exact reimbursement until you call your insurance company with the specific billing codes your midwife uses (typically CPT 59400 or 59510 for global maternity care).
After reimbursement for $5,000 midwife fee
Source: MANA 2023 consumer survey data
Medicaid covers home birth with a licensed midwife in 49 states (Alabama is the exception). This includes certified nurse-midwives (CNMs) in all states and certified professional midwives (CPMs) in about 35 states, depending on your state's Medicaid policies.
The bigger problem is access, not coverage. Many midwives don't accept Medicaid because reimbursement rates are low ($1,500-$3,000 for global care, compared to $4,000-$6,500 private pay). In some states, only 10-20% of home birth midwives take Medicaid clients. You may need to call 10 or 15 practices to find one with availability.
If you have Medicaid, start looking for a midwife as early as possible, ideally before 12 weeks. Some practices reserve a few spots for Medicaid clients each month. Others work on a sliding scale or payment plan if you're willing to pay the difference between Medicaid reimbursement and their full fee.
You'll pay your midwife in full, usually in installments during pregnancy, and then file a claim with your insurance after the birth. Your midwife will give you a superbill, which is an itemized receipt with the billing codes your insurance needs (diagnosis codes for pregnancy, procedure codes for prenatal care and delivery).
You submit this superbill to your insurance company, either by mail, fax, or through their online portal. Reimbursement typically takes 4-8 weeks. Some plans require you to meet your out-of-network deductible first, which can be $2,000-$5,000 depending on your plan.
If your claim is denied, ask for the denial reason in writing and appeal it. Common denial reasons include "out-of-network provider" (appeal by showing your plan covers out-of-network maternity care), "not medically necessary" (appeal with evidence-based research on home birth safety for low-risk pregnancies), or "place of service not covered" (appeal by citing your state laws if home birth is legal and licensed).
Yes. You can use Health Savings Account (HSA) or Flexible Spending Account (FSA) funds to pay for your midwife, birth supplies, and postpartum care. These are qualified medical expenses under IRS rules, and paying with pre-tax dollars reduces your effective cost by 20-30% depending on your tax bracket.
You can also use HSA/FSA funds for doula care, childbirth classes, breast pumps, and prenatal vitamins. If you transfer to the hospital during labor, those costs are covered too. Keep itemized receipts for everything in case of an audit.
If you're planning a home birth and have a high-deductible health plan (HDHP) with an HSA, you can max out your HSA contributions during pregnancy to cover both the midwife fee and your hospital deductible if you transfer. For 2024, the HSA contribution limit is $4,150 for individuals and $8,300 for families.
Call the customer service number on your insurance card and ask these specific questions: Does my plan cover out-of-network midwifery care? What are the billing codes you reimburse for global maternity care (CPT 59400 or 59510)? What is my out-of-network deductible and coinsurance rate? Do you require preauthorization for maternity care?
Write down the representative's name, date, and a reference number for the call. Ask them to send you the coverage details in writing via email or your insurance portal. Insurance reps sometimes give incorrect information over the phone, and having documentation helps if you need to appeal a denied claim.
Your midwife can also help you verify benefits. Many practices offer a verification service or can connect you with a medical billing specialist who works with home birth families. Some midwives won't take you on as a client until you've confirmed your coverage in writing, which protects both of you.
Your insurance covers hospital care the same way it would for any birth, using your in-network or out-of-network hospital benefits. If you transfer during labor and deliver at the hospital, you'll have two separate bills: one from your midwife for prenatal care and labor support, and one from the hospital for delivery and postpartum care.
Most midwives charge a reduced fee if you transfer before delivery, typically 50-70% of the global fee since they provided prenatal care but not the birth itself. You'll still submit a claim to insurance for the midwife's services. The hospital bills insurance directly for their portion.
Transfer doesn't mean your out-of-pocket costs double, but you will pay your hospital deductible and coinsurance on top of whatever your insurance doesn't reimburse for the midwife. If you've already met your deductible for the year through prenatal care, the hospital portion may cost less than you expect.
Before you pay a deposit to a midwife, call your insurance company and ask exactly what they reimburse for out-of-network global maternity care using the billing codes your midwife provides. Get the answer in writing, and factor the realistic reimbursement amount into your budget, not the best-case scenario. If you have Medicaid, start calling midwives early because availability is limited, and be prepared to expand your search radius or consider a CPM if CNMs in your area don't accept it.