Is a Birth Center Less Expensive Than a Hospital?

By Igel Cudiera

For a healthy, low-risk pregnancy, research has found that birth center care often costs less overall than hospital-based care, largely because it tends to involve fewer cesarean births and shorter stays. Whether it costs you less is a separate question. Your share depends on your insurance, your location, the providers and facility you use, what your care includes, and whether you need hospital care at any point during pregnancy, labor, or after the birth.

Below is what the research actually measures and how birth center and hospital bills are usually put together. You'll also see when the setting makes a real difference to your out-of-pocket cost, when it barely matters, and what to ask before you compare numbers. If you're still weighing where to give birth, it may help to start with the birth settings available in Nassau County.

What the Research Says About Birth Center Costs

The strongest evidence comes from Strong Start for Mothers and Newborns, a federal initiative that studied Medicaid and CHIP enrollees between 2013 and 2017. People who received prenatal care through the birth center model had average costs that were $2,010 lower per mother and baby, from birth through the baby's first year. That held regardless of whether they ultimately gave birth at the birth center or in a hospital.

According to the Centers for Medicare & Medicaid Services (CMS), those lower costs were likely driven by two things: lower cesarean rates and shorter stays at the birth facility. Fewer emergency room visits and hospital stays for babies during the first year added to the savings. The cesarean rate among birth center participants was 17.5%, compared with 29% in a comparison group matched for risk. In interviews with birth center staff and Medicaid officials in 20 states, birth center facility fees for an uncomplicated vaginal birth were also reported to be 15% to 70% lower than hospital payments in many states.

Two things are worth keeping in mind when you read numbers like these:

• They describe what Medicaid paid, not what families paid. Lower payer costs don't automatically mean a lower bill for you.
• They apply to low-risk pregnancies. Birth centers are designed for healthy pregnancies expected to have an uncomplicated birth. The American College of Obstetricians and Gynecologists (ACOG) describes accredited birth centers as freestanding facilities that care for low-risk patients with uncomplicated, single, full-term, head-down pregnancies. New York's regulations likewise define midwifery birth centers as serving patients at low risk.

Birthing Center vs Hospital Cost: How the Bills Are Built

Part of what makes birthing center vs hospital cost hard to compare is that the two settings don't always bill the same way. Knowing the pieces makes it much easier to ask useful questions.

How hospital births are usually billed

A hospital birth can involve more than one party sending a bill: the hospital itself and the clinicians who care for you there. Because of this, a clinician who treats you at an in-network hospital could be out of network. The federal No Surprises Act protects you from unexpected out-of-network bills related to non-emergency care at in-network hospitals, hospital outpatient departments, and ambulatory surgical centers. It's still worth confirming network status for each provider you're likely to see.

What birth center care may include

Birth centers vary in what they bundle together. Some bill prenatal visits, labor and birth, and postpartum care together. Others bill certain services separately, such as lab work, ultrasounds, classes, or supplies. There's no standard package, so the most useful thing you can do is ask for a clear list of what is and isn't included before you start care.

Your baby's care is billed separately

Wherever you give birth, your newborn has health care costs of their own. In national claims data for people with employer-sponsored insurance, the Peterson-KFF Health System Tracker counted newborn costs separately from the birthing parent's. Newborns (children enrolled for less than three months) averaged $5,820 in total health spending, of which $475 was paid out of pocket. If you have private insurance, add your baby to your plan promptly. On a Marketplace plan, the birth opens a special enrollment period, and coverage can start on the day of the birth if you enroll within 60 days.

Use this table as a checklist when you compare settings:

Why Your Own Cost May Not Match the Averages

National averages give a sense of scale, but they rarely predict an individual bill. The Peterson-KFF Health System Tracker analyzed 2021 to 2023 claims for people with employer-sponsored insurance. On average, pregnancy, childbirth and postpartum care cost $20,416, including $2,743 paid out of pocket. Pregnancies ending in a vaginal birth averaged $15,712 ($2,563 out of pocket), and those ending in a cesarean averaged $28,998 ($3,071 out of pocket). These are averages for people with employer plans, not prices for any particular hospital or birth center.

Location matters too. In a June 2026 release, FAIR Health reported that New York had the third-highest median in-network allowed amount for a vaginal delivery among U.S. states. That means national figures may not reflect what a birth costs in New York. Ask your insurer for estimates based on your own plan and providers.

What you actually owe comes down to how your plan shares costs:

• Deductible: the amount you pay for covered services before your plan starts to pay.
• Coinsurance: the percentage of a covered service's cost you pay after meeting your deductible, such as 20%.
• Out-of-pocket maximum: the most you pay for covered services in a plan year. After you reach it, your plan pays 100% of covered in-network services. For 2026 Marketplace plans, the out-of-pocket maximum can be no more than $10,600 for an individual or $21,200 for a family, and your plan's limit may be lower.

When the setting makes little difference to what you pay

• You've already reached your out-of-pocket maximum for the year, or expect to. Once you reach it, a lower total cost for covered in-network care may not change your share.
• Your deductible is high relative to the total cost of care. If either setting would use up most or all of your deductible, the difference you see may be small.
• Your plan charges little or nothing for maternity care in either setting. If both the birth center and the hospital accept your plan and your share is minimal in each, the lower total cost mainly benefits the payer. Ask your plan to confirm what you'd owe in each setting.

When it can make a bigger difference

• Your plan uses coinsurance and you're nowhere near your out-of-pocket maximum. A percentage of a smaller total is a smaller number.
• Network status differs. If one setting is in network and the other isn't, that can outweigh any difference in the underlying price.
• Your pregnancy spans two plan years. If your plan runs on a calendar year, a due date in January or February can mean prenatal care falls under one year's deductible and the birth under the next.

What Happens to Costs If You Need a Hospital?

This is the question that matters most when comparing costs honestly, because a transfer can mean you receive care, and possibly bills, from both a birth center and a hospital.

Transfers aren't rare. The National Birth Center Study II followed 15,574 women at 79 midwife-led birth centers in 33 states who were planning, and eligible for, a birth center birth when labor began. Of these, 84% gave birth at the birth center, 4% were transferred to a hospital before being admitted, and 12% were transferred during labor. Among those who gave birth at the center, 2.4% needed transfer after the birth, and 2.6% of newborns were transferred. Most transfers were not emergencies: 1.9% of mothers or newborns needed an emergency transfer. Regardless of where they gave birth, 6% had a cesarean.

If your pregnancy changes before labor

Birth center eligibility is reassessed throughout pregnancy. If a condition develops that makes a hospital the more appropriate place to give birth, your prenatal care may move to an obstetric practice, a hospital, or both. Ask the birth center how it bills the prenatal care you've already received, and whether anything paid in advance is refunded or credited.

If you transfer during labor or after the birth

A transfer during labor can bring hospital facility charges, physician or midwife fees, and possibly ambulance costs. The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits. Ground ambulance services, however, are generally not covered by its billing protections unless state law sets different rules. Ask your insurer how ambulance transport is covered under your plan. Ask the birth center the same question it would have to answer for any family: what are you billed for at the center if your birth ends up happening in the hospital?

None of this is a reason to avoid birth center care. It's a reason to ask about transfers before you sign on, rather than after.

Insurance and Medicaid Coverage for Birth Centers in New York

A few rules shape what's covered in New York, though your plan's own terms always decide the details:

• Maternity care is an essential health benefit. Marketplace plans must cover pregnancy, maternity and newborn care.
• New York requires individual health policies to cover maternity care to the same extent as care for illness. Under Section 3216 of the state's Insurance Law, that coverage must include the services of a licensed midwife who is affiliated with, or practicing in conjunction with, a facility licensed under Article 28 of the Public Health Law. Self-funded employer plans fall outside the jurisdiction of the New York State Department of Financial Services, so their rules can differ.
• Medicaid covers freestanding birth centers in states that recognize them. Under Section 2301 of the Affordable Care Act, states that recognize freestanding birth centers must cover birth center facility services under Medicaid and pay for them separately.

Coverage for a hospital birth doesn't automatically mean coverage at a freestanding birth center, and the midwives and the facility may be in network separately. Licensing matters here too. If you're unsure what separates licensed and unlicensed birth centers, it's worth understanding before you compare quotes.

At Birthing Center Long Island, we accept Medicaid and work with many private insurance plans. Our billing team verifies your benefits and helps you understand the coverage available under your plan. You can find details in our insurance information. Families who would rather give birth in a hospital can also look into a planned hospital birth with our midwives.

Questions to Ask Before You Compare Costs

Your insurance company

• Is the birth center covered as a place of birth under my plan, and is it in network?
• Are the midwives in network, separately from the facility?
• How much of my deductible have I met, and what is my coinsurance for maternity care?
• What is my out-of-pocket maximum, and does my pregnancy cross two plan years?
• Is the hospital the birth center transfers to in network?
• How is ambulance transport covered?

For a full step-by-step checklist, see our guide on how to verify your maternity benefits.

The birth center

• What is included in your care, and what is billed separately?
• Do you bill a facility fee and a midwifery fee, or one combined fee?
• What happens to billing if I need to transfer before or during labor?
• Which hospital do you transfer to?
• Do you offer payment plans, and when are payments due?

The hospital, if you're comparing

• Which separate bills should I expect for labor and birth?
• Are the doctors, anesthesia providers and pediatricians who may see me in network?
• If I'm uninsured or paying myself, can I get a good faith estimate?

That last question matters. If you're uninsured or choose not to use your insurance, providers usually must give you a good faith estimate if you ask for one, or if you schedule care at least three business days ahead. If your final bill is at least $400 more than the estimate, you may be able to dispute it.

Benefits checks take time, so it helps to start early. Our article on how early to contact a birth center explains the timing.

A Note From Our Midwifery Practice

Cost is a fair thing to weigh, and families shouldn't feel uncomfortable asking about it. When you weigh birthing center vs hospital cost, we'd encourage you to use your own plan's numbers rather than averages you find online, including the figures in this article. Two families with the same due date can owe very different amounts depending on their coverage.

What we'd hope you won't do is choose a birth setting on cost alone. The right place to give birth depends on your health history, how your pregnancy progresses, and the kind of care you want. When cost and care both fit, the decision tends to feel much clearer. If something changes along the way, your midwives will explain why and help you plan what comes next.