Are doulas covered by insurance? It depends on where you live

Are doulas covered by insurance? The short answer is yes. But unfortunately, it’s not that simple.

Insurance-covered doula services are relatively new: A benefit that didn’t exist nine years ago when I first learned about doulas.

I first heard the term “doula” while eight months pregnant with my first son. At the time, I’d worked in the healthcare space for more than a decade, as a biomedical engineer at some of the top medical device companies in the country. With a focus on research and development for medical devices specific to women’s health, I thought I knew everything there was to know about pregnancy and new mom life.

So imagine my surprise when a friend dropped the word “doula” and my face went blank. There I was, just weeks away from giving birth, only now learning there was an option to have a dedicated support person to help me physically and emotionally during pregnancy, birth and postpartum. How did I not know about this? Turns out this type of non-medical, professionally trained support person can improve health outcomes during labor and delivery for both mom and baby, that is, if you can pay for it out-of-pocket. And because I was feeling so overwhelmed and lost leading up to giving birth, I decided it was an expense I’d take on.

My doula helped make the end of my pregnancy, labor, delivery, and those first few days postpartum some of the most cherished memories I have. The support I received, the confidence she instilled in me to advocate for my wants and needs, and the guidance she provided to help me thrive as a new mom during those early days was priceless.

It got me thinking: Why hadn’t I heard about this earlier in pregnancy? Did others know this was an option? Why wasn’t this the standard of care? And what did families do if they couldn’t afford to pay for this clinically beneficial service without insurance coverage?

I started talking about my experience with my doula and quickly realized that many people were unaware that doula services existed. And those who needed those services most couldn’t afford them.

That was something I couldn’t live with—and it’s what led me to found Flourish Care, a maternal healthcare company that blends tech and in-person care, empowering families with wellness programs and doula support covered by insurance from pregnancy to parenthood. Now, almost a decade later, the US is finally starting to provide community-care benefits like doula care through insurance, primarily for Medicaid participants, but it’s growing.

Here’s a breakdown of what that insurance coverage for doulas looks like, what you need to know to access it and the benefits that doula care will provide you during your pregnancy and parenting journey.

Which states have insurance-based doula services?

The number of states taking steps toward Medicaid doula reimbursement has more than doubled from 2022 to 2024. Currently, 43 states and Washington, DC are working toward providing families with doula reimbursement options, with 14 states actively reimbursing Medicaid patients. Those states that are actively reimbursing for doula care include Massachusetts, New York, New Jersey, Maryland, Virginia, Michigan, Florida, Oklahoma, Minnesota, Oregon, Nevada, California and Washington, DC.

Right now, only Rhode Island, where Flourish Care is headquartered, and Louisiana have doula care covered for those with commercial insurance plans under law. But it’s worth celebrating that states are recognizing the benefit of doulas in improving the maternal health crisis.

What are the benefits of using a doula?

Doulas work directly with the birthing parent and the medical care team to make sure the birthing parent has the confidence needed to advocate for themselves and feel supported during labor and delivery.

It’s clinically proven that patients who add doulas to their care team reduce their risk of having a preterm birth, reduce the risk of having their baby in the Neonatal Intensive Care Unit (NICU), lower their change of having of unnecessary or unwanted c-sections and reduce birth inequities.

In addition to offering support during pregnancy and labor, postpartum doulas, which are also now covered by some insurance plans, can help new parents in those immediate weeks after having a baby. Those services include helping with caring for the newborn, helping with food preparation and doing laundry, to name a few.

Finally, most insurance plans that cover doula support offer coverage for all situations, including patients who deliver full-term, patients who deliver early or in the event of a pregnancy loss or termination. Through these new reimbursement laws, patients are getting access to a support system that can help alleviate stress and provide needed support for patients.

How do I know if I’m eligible for insurance-covered doula services?

One of the biggest challenges with state-by-state or insurance-specific doula coverage is it’s hard to find out if your insurance covers doulas, how much support you are eligible for with no out-of-pocket costs, and then finding a doula that meets your specific needs and preferences. That’s one of the many reasons I started Flourish Care; as a way to take the heavy lifting off of you and your medical providers. If you are reading this and live in Massachusetts or Rhode Island, you can visit Flourish Care, enter your insurance information and we will let you know your eligibility based on your coverage—and match you to a doula within a week.

If you are reading this and live in another state, here are a few ways to figure out if you are eligible for doula services and how you can pay for them.

• Ask your doctors: A doula should work in conjunction with your medical care team. Therefore, the first place to go is your OB-GYN office. If you want to incorporate a doula into your care team, advocate for this support and ask your doctor how they can help you find out if insurance will cover the additional care. Your doctor is your first line of defense.

• Call your insurance company: This is not my favorite piece of advice, but unfortunately, in the current landscape, it’s one of the only ways to find out if your insurance plan does cover doula services. We are on a mission to change that, but until then, if you call the number on the back of your insurance card, you can find out if your insurance covers it. Here are some talking points that can help you get to the right person, quicker:

  • The first step is calling member services and asking if you have doula benefits

  • If you do have benefits, member services will give you a list of providers in your region

  • You can let member services know that doula services usually fall under maternity benefits. If it’s not listed there, that means your insurance doesn’t cover doula services. In terms of reimbursement, that may vary based on your state. But it can be anywhere from $750 to $3,200 dollars for services.

• Use your HSA or FSA Cards: If your insurance doesn’t cover services, or you are looking for more coverage than your plan offers, you can often use an HSA or FSA card.

• Talk to your Employer’s Human Resources Department: If your company offers Maven or Carrot benefits, you could have access to doula services. All you have to do is contact your company’s human resources department and ask if your Maven or Carrot benefits cover doula services. Many times you will have access to funds from there that can help you pay for prenatal, labor or postpartum doula services. It’s another way you could get doula services without having to pay out of pocket.

Why should we advocate for universal, insurance-covered doula services?

The US has the worst maternal mortality rate out of any developed nation. But the numbers don’t add up: There is no reason why the US is spending the most on healthcare than any other high-income country and also has the highest maternal mortality rate. And given the fact that more than 80% of maternal deaths in the US are considered preventable with the right care and necessary interventions—it’s a no-brainer for insurance companies to cover doula services.

Doulas are standard of care in almost every other country in the world. Research shows that adding this type of community-care provider to your care team improves birth outcomes, reduces stress for the birthing parent and partner, shortens labor times and provides culturally-competent care and support to expectant parents in minority or low-income communities. Oh, and it reduces healthcare costs.

So while only a handful of states and insurance companies currently provide reimbursement for doula care, I am on a mission to get doula services covered by all insurance companies, both for Medicaid patients and for those patients with commercial or personal policies. And I’m not alone in my quest: A handful of US lawmakers recently reintroduced the Mamas First Act, a federal bill that would expand Medicaid to include doula and midwifery support. The goal of the legislation is to combat the maternal health crisis by expanding coverage to include community-based support like doulas.

My doula changed my birthing and new-motherhood experience for the better. This type of care for new parents should be the norm. As mothers, we deserve the best. And insurance-covered doula care is one way to help us get it.