If you’re a millennial on the fence about becoming a parent, you’ve probably heard the phrase, “It costs $1 million to raise a child through college.” (*insert white guy blinking meme*, gee, no wonder the American birth rate just keeps getting lower.)

While that’s not necessarily true, the average middle-income family with two children will spend $310,605 to raise a child born in 2015 up to age 17, according to the Brookings Institution. To my knowledge, these costs include housing, which…I mean…you’re probably paying for that anyway, right? But it highlights how the decision to start a family usually means opening a big, fat tab.  

So you can imagine my surprise when I learned that even physically birthing a baby was probably going to run at least a four-figure bill, even with insurance. (USA! USA!) 

So how much does having a baby cost?

Several months ago, we polled our Instagram audience about the biggest “surprise” costs they’ve ever incurred. Here’s some news that won’t be surprising to parents and homeowners the world over: The most frequent expenses pertained to things like roofs, HVACs, and, yes, having babies.

Totals without health insurance

While the costs of childbirth widely vary, the Peterson-Kaiser Family Foundation Health System Tracker (a quippy name if I’ve ever heard one) found that the average cost of giving birth—including pregnancy, delivery, and postpartum care—is $18,865 for people without health insurance.

The average cost of vaginal deliveries is $14,768, and the average cesarean runs a staggering $26,280. 

Fortunately, under the Affordable Care Act, pregnancy, labor, delivery, and newborn baby care must be covered by all health insurance plans. Similarly, all preventive and prenatal services must be provided without copays, to make this experience more affordable. (So, like…we’re moving in the right direction, I guess?)

Totals with health insurance

Rockin’ that fancy UnitedHealth plan via your benevolent corporate benefactor? Incredible news for you, Glen Coco! Your average out-of-pocket cost drops to $2,854—not exactly cheap, but a hell of a lot better than the near-$20,000 bill we were running before. (For vaginal deliveries, the average is $2,655 and cesareans are $3,214, for context.)

But take it from me, your favorite non-mother: Having a baby is…kinda unpredictable.

You don’t exactly get briefed a week ahead of time by your medical virtual assistant that Baby’s going to prefer a C-section over a vaginal birth. That means you may not really know your final amount owed for several months after delivery, and that can shock you out of baby bliss and back to reality pretty quickly. Baby better pick up a shift or two.

Here are the known factors you can plan for:

• Where do you plan to deliver? Costs vary by state, hospital, and healthcare plan—often mandated by said state—so you want to get familiar with the averages in your area. For example, according to Forbes Advisor, South Dakota, Nebraska, Idaho, and Alaska are the most expensive states to give birth in (South Dakota? Really?), and Washington, DC; Michigan; and Maryland are among the lowest. (Bonus: If you give birth in Maryland, you can raise your kiddos on crab cakes!) Home births with a midwife may be more affordable than hospital stays, but of course, consider factors like risk tolerance, safety, etc.

• Do you anticipate any additional charges? This could include complications or situations like high-risk pregnancies (triplets!), gestational diabetes, cesarean deliveries, NICU care for the baby post-birth, etc. Again, it’s not always easy to know what you might need, but your doctor may be able to help provide some additional context or realities of what to expect based on your pregnancy.

• What is your healthcare plan and coverage? It’s very possible that your insurance maximum or deductibles could be reached by the time you go into labor, so hey, if you’ve been waiting on that rotator cuff surgery…might as well just stack the year with deductible-busting care! #Efficiency. Check out your healthcare plan documents and get familiar with your plan to understand what you may be on the hook for during pregnancy, delivery, and postpartum, as well as the coverage for your new baby in your plan. (Surprise: Your baby has their own deductible, because after they’ve been in this world for approximately a month, they, too, get to experience the joys of being exploited by privatized healthcare. You can add Baby into your family’s plan as part of the Special Enrollment Period.)

To minimize any increases in cost, you can also try to prioritize in-network providers and to compare hospitals and doctors for the lowest prices. The new “No Surprises” legislation should prevent you from getting a bill for an out-of-network doctor at an in-network hospital—but check your state laws, because there may be loopholes and ambiguities.

After your child has graced the world with its presence, the following items are also likely to come up on your running balance sheet:

• Newborn visits

• Medications or follow-up appointments for the parent (or longer hospital stays if there are complications)

• Breastfeeding equipment (the good news is that, thanks to the Affordable Care Act (ACA), health insurers must cover the cost of a breast pump…but why do breast pumps cost up to $400?)

The majority of insurance plans in the US (thanks to the aforementioned Affordable Care Act) will cover many of your expenses, though you should deep dive into your own coverage to be sure. To make things easier and as you work with an OB-GYN or midwife on a birth plan, you can ask your healthcare company questions like:

1. Which common delivery needs are or aren’t covered by my policy?

2. Does my policy cover a private room? 

3. How long a stay is covered after delivery? (Word on the street is they punt you outta there quick, so don’t get too cozy.)

Nerdwallet has a robust list of questions you can pose—and to be safe, getting your provider’s responses in writing and/or always noting (a) who you talked to and (b) when can help cover your you-know-what later.

If you’re having a baby and don’t have access to health insurance

If you don’t have access to insurance, you can consider asking for a discounted cash rate from your provider. You might also consider government health insurance (like Children’s Health Insurance Program, or CHIP) or programs similar to Moms & Babies in Illinois for potential coverage.

If you don’t plan to have a child in the immediate future but it’s on your radar, you can check out this piece Money with Katie did on budgeting for healthcare in the US to help navigate your premiums, out-of-pocket expenses, and deductibles when the time comes.

If you have access to an HSA, you could set aside pre-tax dollars for this impending expense. The HSA will roll over year after year so it can help offset a larger bill, if you need, though ideally you’d pay out of pocket and allow your HSA to continue compounding tax-free for later if at all possible. (Just a little “optimization” tip that might work better in theory than in practice, but still worth noting.)

Finally, the Kaiser Family Foundation found that 45% of single-person households didn’t have more than $2,000 in liquid assets available to pay medical bills. Even with insurance, most single parents wouldn’t be able to incur the costs of childbirth without potentially disastrous financial outcomes. 

While that’s a larger issue to unpack another time, I can’t help but notice how necessary new humans are for society (and the economy) to continue functioning. Charging $18,000 for childbirth just prices more and more people out of being able to have children, let alone to raise them. 

We’re also covering the costs of infertility and accessing fertility treatments like intrauterine insemination (IUI), in-vitro fertilization (IVF), and adoption over on The Money with Katie Show podcast this week. And on our YouTube channel, we’re talking about ways to afford those fertility treatments. We’re all about being comprehensive over here—so check it out if you’re curious.