Starting this summer, U.S. patients giving birth may face higher out-of-pocket costs under a new Medicare billing policy—despite no change in clinical protocols. The shift, announced by the Centers for Medicare & Medicaid Services (CMS) following Tuesday’s regulatory update, reclassifies obstetric services from “global” to “separate” billing, splitting payments for prenatal, delivery, and postpartum care. This could add $1,500–$3,000 to average birth-related expenses for uninsured or high-deductible patients, according to a KFF analysis published this week.
Why This Policy Change Could Leave New Parents Financially Vulnerable
The CMS decision stems from a 2025 audit revealing 42% of U.S. hospitals underbilled for postpartum care by misclassifying it as part of the “global obstetric package”—a bundled payment model that covered all services from labor through 60 days postpartum. While the policy aims to correct billing discrepancies, it inadvertently exposes a structural flaw: the U.S. remains the only high-income nation without universal maternity coverage. With 1 in 5 U.S. births already paid out-of-pocket [^1], this change risks deepening disparities for marginalized groups, who face both higher maternal mortality rates (2.5x for Black women) and lower insurance enrollment.
In Plain English: The Clinical Takeaway
What’s changing? Hospitals will now bill separately for prenatal visits, delivery, and postpartum care—meaning patients may see multiple bills instead of one bundled charge.
Who’s most affected? Uninsured patients or those with high-deductible plans (e.g., ACA marketplace enrollees) could owe $1,500–$3,000 more per birth, per KFF projections.
Does this impact care quality? No—clinical guidelines (e.g., ACOG’s postpartum care standards) remain unchanged, but financial barriers may delay follow-up visits.
How the Billing Shift Exposes a Public Health Crisis
This policy intersects with three critical trends:
Rising maternal mortality: The U.S. maternal death rate (23.8 per 100,000 live births in 2022 [^2]) is driven partly by delayed postpartum care—now, financial hurdles may worsen this.
Insurance gaps: Only 61% of U.S. women of reproductive age have employer-sponsored insurance [^3], leaving millions vulnerable to surprise bills.
Hospital consolidation: 70% of U.S. births occur in for-profit hospitals [^4], where billing complexity often obscures true costs.
Contrast this with the UK’s NHS, where maternity care is fully covered: a 2023 Lancet study found no out-of-pocket costs for postpartum visits, correlating with a 30% lower readmission rate for complications [^5]. The U.S. system, by design, treats birth as a commercial transaction rather than a public health priority.
What the Data Shows: Who Pays the Price?
The financial impact varies sharply by geography and insurance status. Below, a comparison of projected costs for uninsured patients in three states:
State
Avg. Out-of-Pocket Cost (Pre-Change)
Projected Cost Increase (Post-Change)
% of State Below Federal Poverty Line (2025)
Texas
$2,800
+$2,200
15.5%
California
$1,900
+$1,500
13.2%
Florida
$3,100
+$2,500
14.8%
Source: KFF analysis of CMS billing codes and state poverty data (2025 projections).
Critically, these increases disproportionately affect Black and Hispanic women, who are 2–3x more likely to lack insurance [^6]. A 2024 JAMA Network Open study linked financial barriers to 40% higher odds of skipping postpartum care [^7].
Expert Voices: What Clinicians and Policymakers Warn About
“This isn’t just a billing tweak—it’s a public health experiment with patient lives. We’ve seen in Texas, where uninsured rates are highest, that women delay care until complications arise. Now, we’re adding a financial speed bump to an already broken system.”
From 1-10, how comfortable are you completing the CMS 1500 form? #medicalbiller #medicalbilling
“The CMS decision ignores the mechanism of action behind maternal health disparities. Financial stress activates the hypothalamic-pituitary-adrenal (HPA) axis, elevating cortisol levels—linked to preterm birth and hypertension. This policy will worsen those biological pathways.”
Contraindications & When to Consult a Doctor
While the policy itself doesn’t alter medical protocols, the financial strain may create secondary risks for patients. Seek immediate medical attention if:
Postpartum hemorrhage: Heavy bleeding (>1 pad/hour for 2+ hours) or clots larger than a grapefruit. Why? Delayed care increases mortality risk by 3x [^8].
Severe hypertension (pre-eclampsia): Blood pressure ≥160/110 mmHg with proteinuria (urine protein >300 mg/24h). Why? Untreated, this progresses to HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) in 12–24 hours.
Infection signs: Fever >100.4°F, foul-smelling lochia (postpartum discharge), or red streaks on incision sites. Why?15% of postpartum infections require hospitalization [^9], and delays raise sepsis risk.
For patients facing billing barriers: Contact your hospital’s financial counselor (required by the Patient’s Bill of Rights) to negotiate payment plans. Nonprofits like March of Dimes offer grants for uninsured mothers.
What Happens Next: The Regulatory and Political Battleground
The CMS change takes effect July 1, 2026, but legal and legislative challenges loom:
State-level pushback: California and New York have introduced bills to mandate hospital transparency on out-of-pocket costs, citing this policy as a catalyst.
ACA expansion: The Biden administration is accelerating Medicaid postpartum coverage extensions (currently 12 months post-birth in 38 states) to 24 months, but full implementation won’t occur until 2027.
Hospital responses: Nonprofit systems (e.g., Catholic Health Initiatives) may absorb costs to retain patients, while for-profits could raise prices further.
Internationally, the shift underscores the U.S.’s outlier status: 98% of high-income countries cover maternity care as an essential benefit [^10]. Even Switzerland, with its market-driven system, caps birth-related costs at $3,000—less than many U.S. deductibles.
The Bottom Line: A Policy That Prioritizes Bureaucracy Over Patients
This billing change is a symptom of a larger failure: the U.S. treats birth as a commodity rather than a public health imperative. The data is clear—financial barriers delay care, increase complications, and widen disparities. While CMS frames this as a “correction,” the real correction needed is universal coverage. Until then, patients—especially those already marginalized—will bear the cost.
Disclaimer: This article is for informational purposes only and not a substitute for professional medical advice. Always consult a healthcare provider for personalized guidance.
Dr. Priya Deshmukh
Senior Editor, Health
Dr. Deshmukh is a practicing physician and renowned medical journalist, honored for her investigative reporting on public health. She is dedicated to delivering accurate, evidence-based coverage on health, wellness, and medical innovations.
