Midwife care is covered by most health insurance plans, but the extent of coverage depends on the type of midwife, your insurance plan, and where you give birth. Certified nurse-midwives (CNMs) have the broadest insurance coverage, while other types of midwives are less consistently covered. The details matter, and they can mean the difference between a fully covered birth and thousands of dollars in surprise bills.
What Most Private Insurance Plans Cover
The Affordable Care Act requires all marketplace plans to cover maternity and newborn care as an essential health benefit. Because certified nurse-midwives are licensed healthcare providers who can bill using the same procedure codes as OB-GYNs, most private insurers will cover their services when they’re in-network and practicing in a covered facility. The billing codes for prenatal visits, vaginal delivery, and postpartum care are the same regardless of whether a midwife or physician provides the care.
That said, “covered” doesn’t mean “free.” You’ll still owe your normal deductible, copays, and coinsurance. And the key phrase is “in-network.” If your plan doesn’t have any midwives in its provider network, you may need to pay out-of-network rates or petition your insurer for an exception. Many insurance networks are thin on midwifery options, so check your plan’s provider directory before assuming you can see one at in-network rates.
Medicaid Coverage for Midwives
Federal law requires every state Medicaid program to cover certified nurse-midwife services. This is not optional for states. However, how much Medicaid pays midwives varies significantly. As of mid-2023, roughly half of states reimburse CNMs at the same rate as physicians for identical services. The remaining 20 or so states pay midwives between 75% and 98% of the physician rate.
Lower reimbursement rates matter to you as a patient because they discourage midwives from accepting Medicaid, which can make it harder to find one in your area. If you’re on Medicaid managed care, your plan is required to maintain an adequate provider network, but a 2024 report from the HHS Office of Inspector General found that many states don’t specifically require their managed care organizations to include midwives in their networks. States tend to measure network adequacy by counting OB-GYNs and hospitals, not midwifery practices.
How Birth Setting Affects Coverage
Where you plan to give birth has a major impact on whether insurance will pay.
- Hospital births with an in-network midwife are the most reliably covered. Your plan treats the birth like any other hospital delivery, covering both the midwife’s professional fee and the facility fee.
- Birth center births cost less overall, but coverage is inconsistent. Some insurers cover freestanding birth centers, others don’t. Even when the midwife is covered, the facility itself may not be in-network.
- Home births are the least likely to be covered. Many private plans and some state Medicaid programs exclude home birth from covered services entirely, even when the attending midwife holds the same license as one practicing in a hospital.
A handful of states have passed laws requiring insurers to cover birth center or home birth services, but this is still the exception. If you’re planning an out-of-hospital birth, call your insurance company and ask specifically whether the birth setting is covered, not just whether the provider is.
Types of Midwives and Why It Matters
Not all midwives have the same credentials, and insurance companies treat them very differently.
Certified nurse-midwives (CNMs) hold a nursing degree plus a graduate midwifery degree and are nationally certified. They can practice in all 50 states and are recognized by virtually every insurer. When people talk about midwifery being “covered by insurance,” they’re almost always talking about CNMs.
Certified midwives (CMs) have the same graduate-level midwifery training but come from a non-nursing background. They’re only licensed in a handful of states, and insurance coverage outside those states is rare.
Certified professional midwives (CPMs) are credentialed through a different pathway that focuses on out-of-hospital birth. Licensing varies widely by state, and many insurers won’t credential or reimburse CPMs at all. If you’re working with a CPM for a home birth, you should expect to pay out of pocket unless you’ve confirmed otherwise with your plan.
What Midwife Care Costs Without Insurance
If your insurance doesn’t cover midwifery care, or if you choose a midwife or birth setting outside your plan’s coverage, the costs are still typically lower than a physician-attended hospital birth. Midwifery practices commonly offer flat-rate packages ranging from $3,000 to $9,000 that bundle prenatal visits, the birth itself, and postpartum follow-up. Those packages usually don’t include lab work, ultrasounds, or birthing supplies, which add to the total.
For comparison, the estimated national average for just the vaginal delivery portion of midwife care (not including prenatal or postpartum visits) is about $7,400. That figure comes from price-shopping data for uninsured patients and high-deductible plan holders. The wide range reflects geography, birth setting, and what’s bundled into the fee. Many midwifery practices offer payment plans or sliding-scale fees, so it’s worth asking directly.
How to Verify Your Coverage
The most reliable way to find out what your plan covers is a phone call to your insurer’s member services line. Ask these specific questions: whether CNM services are a covered benefit, whether the particular midwife you want is in-network, whether the birth setting (hospital, birth center, or home) is covered, and whether the plan uses a global maternity fee or bills each visit separately. Get a reference number for the call.
If your plan covers midwifery but has no in-network midwives in your area, you can request a network gap exception, which would allow you to see an out-of-network midwife at in-network cost-sharing rates. Insurers don’t advertise this option, but most are required to offer it when their network can’t meet your needs. Put the request in writing and keep copies of everything.