Midwife services are covered by many insurance plans, but the extent of that coverage depends on the type of midwife, your insurance type, where you live, and where you plan to give birth. Certified Nurse-Midwives (CNMs) have the broadest coverage and are reimbursed by virtually every major insurer and all state Medicaid programs. Other types of midwives face a patchier landscape, and home births in particular can be difficult to get covered regardless of your plan.
The Type of Midwife Matters Most
Three types of credentialed midwives practice in the United States, and insurers treat them very differently.
Certified Nurse-Midwives (CNMs) hold a graduate-level degree in midwifery and are also licensed registered nurses. They are the most widely recognized by insurers. Every state Medicaid program reimburses CNMs, and most private plans cover their services the same way they would cover an OB-GYN. If your plan includes maternity care, it almost certainly covers a CNM practicing in a hospital or clinic.
Certified Midwives (CMs) complete the same graduate-level midwifery training as CNMs but do not have a nursing degree. CMs are only legally recognized in about nine states plus Washington, D.C., so insurance coverage for their services is limited to those areas.
Certified Professional Midwives (CPMs) follow a different educational pathway focused on out-of-hospital birth. CPMs are legally recognized in at least 37 states and D.C., but far fewer insurers cover them. Only 18 states and D.C. allow Medicaid reimbursement for midwives without a nursing degree, and private insurers in many states have no obligation to cover CPM services at all. Some states that do reimburse CPMs restrict the settings where they can practice. In Delaware, for example, CPMs can only be reimbursed for outpatient care.
How Medicaid and Private Insurance Differ
Medicaid is actually more straightforward than private insurance when it comes to midwife coverage. Federal law makes Certified Nurse-Midwife services and care at licensed birth centers mandatory Medicaid benefits. That means every state Medicaid program must cover CNM-provided care regardless of the setting.
For CPMs, Medicaid coverage varies dramatically by state. Some states reimburse CPMs through their standard fee-for-service system but not through managed care plans, because managed care organizations don’t contract with that provider type. Virginia is one example of this arrangement. So even in a state that technically “covers” CPMs under Medicaid, your specific Medicaid plan might not.
Private insurance is less predictable. The Affordable Care Act requires marketplace plans to cover maternity care as an essential health benefit, and that care can be delivered by a midwife. But the law doesn’t specifically require insurers to credential or reimburse every type of midwife. In practice, most private plans cover CNMs working in hospitals and clinics. Coverage for CPMs, birth centers, and home births depends on the insurer and the state. A handful of states have passed laws requiring broader midwife coverage, but there is no uniform federal mandate for private plans.
Where You Give Birth Affects Coverage
Even when your midwife is covered, the birth setting can change everything about your reimbursement.
Hospital births with a CNM are covered by nearly all plans that include maternity benefits. The midwife bills using the same procedure codes an OB-GYN would use, so the claim looks familiar to the insurer. A vaginal hospital birth costs an average of $13,562, but your share depends on your deductible and copay structure. Women with employer-sponsored plans pay an average of about $4,945 out of pocket for a vaginal birth.
Birth center births fall in the middle. The average total fee for a birth center delivery is around $8,309. Medicaid is required to cover care at licensed birth centers, and many private plans do too, though not all. Before committing to a birth center, confirm that both the facility and the midwife are in your plan’s network.
Home births are the hardest to get covered. The average global fee for a home birth (prenatal care, delivery, and postpartum visits bundled together) is about $4,650, with prices ranging from $2,000 to nearly $10,000 depending on the practice and region. Some midwives charge insured clients more, with an average fee of $5,050 for those using insurance. Many private insurers simply don’t cover home births, even when the midwife is a credentialed CNM. If your plan does cover it, you may still face out-of-network billing that leaves you paying most of the cost yourself.
How to Check Your Specific Coverage
Start by calling the member services number on your insurance card. Ask these specific questions: Does my plan cover maternity care provided by a Certified Nurse-Midwife? Does it cover a Certified Professional Midwife? Are birth center births covered, and if so, which centers are in network? Is home birth covered under any circumstances?
Get answers in writing. A summary of benefits document may list “midwife services” without specifying which credential types or birth settings qualify, so a written confirmation from your insurer is more reliable than the benefits booklet alone.
If you’re on Medicaid, contact your state Medicaid office or your managed care plan directly. Even though CNM coverage is federally mandated, the details of how claims are processed and which providers are in network still vary. If you want to use a CPM, ask whether your state reimburses that provider type and whether your specific plan (fee-for-service vs. managed care) actually processes those claims.
What to Do if Your Midwife Isn’t Covered
If your preferred midwife or birth setting isn’t covered, you have a few options. Some midwives offer payment plans or sliding-scale fees for uninsured or out-of-network patients. The average delivery-only fee for a home birth is about $3,777, which some families find more manageable than the global package.
You can also submit out-of-network claims to your insurer. Even if the plan doesn’t contract with your midwife, some plans reimburse a portion of out-of-network care. The reimbursement will typically be lower than in-network rates, but it can offset the cost. Ask your midwife’s billing office whether they will submit claims on your behalf or provide you with the documentation to file yourself.
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can be used to pay for midwife services, including those not covered by your plan. If you have access to either account, this is one of the most tax-efficient ways to cover out-of-pocket birth costs.