Maternity fee unbundling is landing in the middle of a healthcare affordability crisis.
Here's how employers can protect their people — and their spend.
Health care costs are already climbing faster than employers have seen in over a decade. Annual premiums for employer-sponsored family coverage hit nearly $27,000 in 2025, a 6% jump that outpaced both wage growth and inflation (KFF, 2025 Employer Health Benefits Survey). Employers are bracing for worse in 2026: Mercer projects health benefit costs will rise 6.5%, the steepest increase in 15 years, pushing per-employee costs above $18,500 (Mercer, 2026 health benefit cost trend).
Maternity fee unbundling arrives directly into that environment. Starting January 1, 2027, the American Medical Association is eliminating the global billing codes that have covered prenatal visits, delivery, and postpartum care as a single bundled fee for more than 40 years. Every visit, lab, and screening will instead be billed individually. That change alone represents a meaningful shift in employer maternity spend, given that maternity care already accounts for 15% to 20% of total employer health care costs.
Why the timing compounds the risk
Under the current bundled model, routine prenatal care functions as a predictable, largely preventive cost. Under unbundling, non-routine visits — for morning sickness, gestational diabetes monitoring, or other complications — are more likely to be coded as specialist or diagnostic care, which can trigger more out-of-pocket spending for patients.
That means the same forces driving health care costs up broadly are about to collide with a billing change that shifts more direct cost onto pregnant workers, at the exact moment they can least afford surprise bills. When people face unexpected out-of-pocket costs, they are more likely to delay or skip prenatal visits altogether.
Managing rising maternity spend starts with knowing what you have
For employers, the most effective response to unbundling isn't just watching claims come in. It's understanding exactly what their health plan already covers, where the gaps are, and what should be added.
Because when employers and HR teams aren’t clear on what’s covered in your health plans, employees aren’t either. With out-of-pocket costs potentially increasing with unbundled billing, patients are more likely to delay or skip care. Conditions like preeclampsia, gestational diabetes, and hypertensive disorders, along with the risk of severe maternal morbidity and mortality, are hardest to detect and manage when prenatal visits are delayed or skipped.
That matters now because the cost of inaction compounds quickly. When employees delay or skip prenatal care due to out-of-pocket cost concerns, the downstream consequences are far more expensive than the care itself. Severe maternal morbidity — life-threatening complications like hemorrhage, eclampsia, and sepsis — affects an estimated 32,500 women a year, and deliveries involving it cost more than twice as much as those without complications; women who experience it are 31 times more likely to die within a year of childbirth (Commonwealth Fund, June 2026). On employer-sponsored plans specifically, the average NICU admission cost $71,158 in 2021, the most recent year available, with the most complex cases exceeding $160,000 (Health Care Cost Institute).
The benefits employees already have — and don't know about
Here's what makes this moment different from a typical cost increase: many employers already have maternal health benefits built into their health plans that would offset exactly this kind of exposure. They're just buried.
Virtual maternity care, on-demand birth and newborn classes, care navigation and other embedded support services often exist inside a plan without ever appearing in a summary plan description or benefits guide. Employees can't use a benefit they don't know they have.
Help employees see what's already covered
That starts with knowing exactly which maternity benefits your plan already includes — whether it's mental health support, care navigation, or coverage for doula and virtual maternity services — and closing the gaps where they don't exist. Just as important is communicating what's already covered clearly enough that employees use it before a cost concern leads them to delay or skip care.
Reproductive & Maternal Health Compass works with employers to identify exactly which maternal, parental and reproductive health benefits already exist inside a health plan and to build the employee communication that drives real utilization. As unbundling reshapes how maternity care is billed, the employers who get ahead of it will be the ones who already know what they're offering — and make sure their people do too.
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