Pregnancy loss: insurers can no longer charge full price for prenatal care

What it does

This bill amends health insurance law to cap out-of-pocket costs for prenatal care when a pregnancy ends in miscarriage or stillbirth. Currently, if an insurer bundles prenatal services with delivery costs and the birth does not occur, patients may face full cost-sharing on prenatal visits. The bill requires insurers to limit those charges to what the patient would have paid if the full bundled delivery had happened—effectively spreading the bundled cost across the prenatal services that did occur, rather than charging full price for care that was part of a package that never completed.

Why we flagged it

The bill's operative mechanism is a cost-sharing cap for a specific patient population (those experiencing pregnancy loss) in a defined circumstance (bundled payment non-completion). It is a targeted consumer protection, not a broad deregulation or industry carve-out.

What the text implies

• The bill applies only to bundled-payment arrangements; patients with non-bundled prenatal coverage are unaffected, potentially creating disparities based on insurance plan design.
• Effective date of January 1, 2027 creates a 2-year lag, meaning patients experiencing pregnancy loss before that date receive no protection under this rule.
• Insurers may respond by restructuring bundled payments or shifting cost allocation, potentially affecting pricing for all patients in bundled arrangements.
• The bill does not address non-financial barriers (time off work, emotional support, follow-up care) that patients experiencing miscarriage or stillbirth face.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Patients experiencing miscarriage or stillbirth face reduced out-of-pocket costs for prenatal care they received. The bill prevents insurers from charging full cost-sharing on prenatal services when the bundled delivery payment is not triggered, which would otherwise leave patients bearing the full financial burden of prenatal care despite the tragic outcome.

Who stands to gain

• patients experiencing miscarriage or stillbirth (reduced out-of-pocket costs)

Named in the bill

Public Health Service Act, Title XXVII, group health plans, health insurance issuers, prenatal services providers

Where it stands

1 cosponsor: 1 Republicans.

• Nov 21, 2025 — Introduced · Congress.gov: “Introduced in House”
• Nov 21, 2025 — Referred to House Committee on Energy and Commerce · Congress.gov: “Referred to the House Committee on Energy and Commerce”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.