Maternity Billing Is Changing in 2027, But the Bigger Story May Be the Opportunity
Beginning January 1, 2027, professional maternity care billing will change significantly. For decades routine prenatal, delivery, and postpartum professional services have generally been grouped within a global maternity bill. According to a recent article from the American Medical Association, under the new structure, professional care will be reported separately across four phases: prenatal care, labor management, delivery, and postpartum care.
For employers, this is more than just a billing change. Claims may appear earlier and at more points throughout the maternity period, potentially affecting claim timing, cash flow, reporting, and administration. The added detail may help employers recognize needs sooner, evaluate maternity resources, and make better-informed health plan decisions.
What is Actually Changing?
A common misconception is that maternity care is moving from one claim to dozens of separate claims that will inevitably increase costs. Employers already see separate claims for certain parts of maternity care.
For example, delivery accounts for approximately 60% of spending across the prenatal, delivery, and 12-month postpartum periods according to a study conducted by the Health Care Cost Institute. Many hospital, anesthesia, and other delivery-related claims are already visible. Laboratory tests, ultrasounds, and other imaging also appear separately.
What will be different is the reporting of routine professional maternity care. The American Medical Association article states that prenatal visits, labor and delivery management, and postpartum care previously grouped within the global maternity bill will appear as individual claims. More claims will not necessarily mean more care or higher total maternity costs. Previously grouped services may simply appear separately.
What This Could Mean for Health Plans and Members?
Pregnancy remains a significant and variable healthcare event for employer-sponsored health plans. Among more than 440,000 births covered by employer-sponsored insurance, average spending across prenatal care, delivery, and 12 months postpartum was $25,669 according to the Health Care Cost Institute study. Although actual plan experience will vary, the new billing structure may change how and when maternity spending appears. Employers may see:
- More frequent professional maternity claims
- Earlier reporting of prenatal and postpartum care
- Changes in claim timing and cash flow
Self-funded and level-funded employers are likely to see these changes first in their claims data. Fully insured employers may not see them directly, although carrier experience could eventually influence pricing.
Additionally, members may receive more explanations of benefits, see professional services listed separately, and have additional questions. Pregnancies spanning 2026 and 2027 may be more complex if services are processed under both billing structures.
The change does not automatically mean higher member costs. Qualifying preventive services may remain covered without cost sharing, while non-preventive care and delivery will follow applicable plan benefits. Member experience will depend on the services received, plan design, and carrier or TPA implementation.
The Hidden Opportunity: Earlier Visibility
Historically, global maternity billing limited employer insight into when routine professional maternity services occurred. More detailed reporting may provide a timelier view of prenatal and postpartum care, creating opportunities to recognize utilization patterns, potential risk factors, and support needs sooner.
This insight may become increasingly valuable as maternal age continues to rise. According to a National Vital Statistics Report article, the mean age at first birth increased by a full year between 2016 and 2024 from 26.6 years to 27.6 years. While the average remains below 35, this upward trend matters because pregnancy at age 35 or older is associated with increased risks of adverse pregnancy outcomes.
Earlier insight may help employers and health plans:
- Recognize potential risks and needs sooner
- Connect members with available resources
- Evaluate whether maternity programs reach members at the right time
- Support members before risks and costs escalate
- Improve support during pregnancy, childbirth, and return to work
Looking Beyond the Billing Change
Employers can begin evaluating how this change may affect their health plan, workforce, and maternity management strategy.
The real opportunity is not simply understanding the billing change. It is using the added visibility and insight to support members sooner and make better health plan decisions.
To learn how your organization can prepare for the transition and use earlier visibility to improve health plan performance and employee experience, contact your Scott Benefits Consultant.
Understanding a change like maternity billing requires more than a financial or clinical risk perspective alone. By integrating both, Scott helps employers see the full picture of health plan performance and make decisions with greater confidence.
