How common home birth is
The CDC's final natality data counted 55,266 home births in the United States in 2023, about 1.5% of all births. That is a small share, but it has nearly tripled since 2004, when home births were 0.56% of births, and it is the highest level in three decades. Midwives attended 41,220 of the 2023 home births; physicians attended 1,567, and the rest were recorded under other or unspecified attendants. About 12% of home births are unplanned, usually because labour moves too fast to reach a hospital — the rest are planned.
The safety evidence behind planned home birth is specific to low-risk pregnancies attended by trained midwives. A 2019 meta-analysis in eClinicalMedicine pooling roughly 500,000 intended home births found no difference in perinatal or neonatal mortality between intended home and intended hospital birth for low-risk pregnancies. That finding does not extend to high-risk pregnancies, unplanned home births or unattended births — and the American College of Obstetricians and Gynecologists recommends hospitals or accredited birth centers as the safest option, while acknowledging that some people will choose home birth and should be supported with a transfer plan.
Transfer is part of the picture, not an exception to it. In the largest U.S. home birth cohort, the Midwives Alliance of North America Statistics Project, 22.9% of planned home births for first-time mothers and 7.5% for mothers who had given birth before ended in transfer to hospital during labour. A plan that covers the home birth but not the transfer, or that treats the transfer as a new and uncovered episode, leaves the most expensive part of the birth uncovered — which is why the transfer question belongs in the insurance conversation, not after it.
Why cover is hard to get
The first obstacle is the network. Many insurers have no midwives in their networks, so even a plan that covers midwifery in principle may have no in-network midwife to bill. Out-of-network midwifery is then paid at out-of-network rates, or not at all, depending on the plan — and a midwife who cannot bill insurance will usually ask for payment upfront. The second obstacle is licensing: certified nurse-midwives are licensed in every state, but certified professional midwives — who attend about three in five planned home births in the U.S. — are licensed or regulated in 38 states. In a state that does not license them, a certified professional midwife generally cannot bill insurance at all.
The third obstacle is Medicaid. Medicaid insures about 40% of the nation's births, but it covers home births in only about half the states, and where it does, it commonly reimburses only services by certified nurse-midwives licensed by the state. A family on Medicaid in a state that does not cover home birth pays out of pocket or gives birth in hospital — there is no federal right to home birth cover. Private plans vary just as widely: some cover home birth with a licensed midwife as a matter of course, some cover it only with prior authorisation, and some exclude it outright.
Cost is the practical consequence. Home birth fees are commonly several thousand dollars when paid out of pocket — one family cited in reporting paid $7,000 with help from a nonprofit — and the fee usually covers prenatal care, the birth itself and postpartum visits as a single package. A plan that covers the birth may still not cover the package as billed, so the question to ask is not “do you cover home birth” but “how do you pay for it, and what part of the midwife's fee counts”.
The questions to ask your insurer
Ask in this order. First, is a home birth with a licensed midwife a covered benefit under my plan, and does it need prior authorisation? Second, which midwives are in network — certified nurse-midwives, certified professional midwives, or neither? Third, how is the midwife's fee paid: as a global maternity fee, per visit, or not at all? Fourth, if labour transfers to hospital, is the hospital birth covered as a continuation of the same episode, and who pays for the ambulance? Fifth, is the newborn covered from birth, and does the newborn need separate enrollment?
Get the answers in writing, or at least the reference number of the call and the name of the person who answered. Coverage answers given on the phone are not binding in the way a written pre-authorisation is, and a home birth is exactly the kind of claim where the plan's written wording — the evidence of coverage — decides the outcome. If the plan says “birthing services by a licensed midwife” without the word “home”, ask whether the place of birth matters; if it says “in a licensed facility”, a home is not a licensed facility.
The same questions apply to employer cover, which is how most working Americans are insured. The site's guide to employer health insurance explains how group cover works, and the Medicare plan comparison guide shows how a different public programme draws its own lines — the pattern is the same everywhere: the plan document, not the brochure, is the contract.
If your plan does not cover it
If the answer is no, the options are to pay out of pocket, to use a freestanding birth center — which more plans cover, and which the Commonwealth Fund found nearly tripled in share between 2004 and 2024, from 0.23% to 0.62% of births — or to give birth in hospital with a midwife-led team. Some families negotiate a cash price with a midwife and submit the bill to the plan afterwards; that sometimes recovers part of the fee, and sometimes recovers nothing, and it should not be assumed to work.
A health care sharing ministry is sometimes suggested as an alternative for home birth costs, and some ministries do share midwifery fees — but a ministry is not insurance, is not legally required to pay, and its guidelines decide what is eligible.
Whatever the route, the transfer plan matters more than the payment plan. Agree with the midwife in advance which hospital you will transfer to, how you will get there, and who will be called — and confirm the hospital is in network for your plan, because an out-of-network hospital birth after a planned home birth is the most expensive surprise this decision can produce.
Worked example
Consider two ILLUSTRATIVE families. The first has a marketplace plan that covers home birth with a licensed certified nurse-midwife in network: the midwife bills the plan, the family pays the plan's cost-sharing, and a transfer to hospital is covered as a continuation of care. The second has a plan with no midwives in network in a state that does not license certified professional midwives: the midwife charges a cash fee, the plan pays nothing, and a transfer to an out-of-network hospital is billed at out-of-network rates. The births are the same; the insurance outcomes are opposite. These are ILLUSTRATIVE contrasts to explain why the coverage question has to be asked before the birth is planned; they predict no real family's costs, and no fee figure is asserted for either family.
Illustrative example only — not a fact about any real policy.