Pregnancy Loss Protection: New Bill Caps Prenatal Care Costs for Families When Bundled Payments Fall Through

The “Caring for Grieving Families Act of 2025” tackles a specific, devastating financial surprise that hits families experiencing the loss of a pregnancy. Specifically, Section 2 targets insurance plans that use a “bundled payment” model for childbirth services—meaning prenatal care, delivery, and postpartum care are all covered under one flat fee. The problem is that if the pregnancy ends in a miscarriage or stillbirth, that bundled payment for the birth never happens, leaving families on the hook for the full, un-discounted cost of all the prenatal care they received.

The Cost-Sharing Safety Net

This section essentially creates a financial safety net. If a plan uses bundled payments and the pregnancy ends in loss, the insurer cannot charge the family more for the prenatal services already received than they would have paid if the birth had occurred. Think of it this way: if your co-pay for the entire bundled service would have been $1,500, the insurance company can’t suddenly bill you $5,000 for the six months of prenatal appointments just because the birth didn't happen. The cost-sharing requirement—like co-pays or deductibles—for those prenatal services must not exceed the cost-sharing amount that would have applied to the full bundled payment.

Who This Helps, and When

This provision is a clear win for consumer protection, designed to prevent families from facing unexpected and substantial medical debt while they are simultaneously dealing with profound grief. It applies directly to group health plans and individual health insurance that rely on those bundled payment models. For example, if you are covered by a plan that uses this structure, and you experience a stillbirth, this rule ensures your out-of-pocket costs for the preceding nine months of care are capped, offering immediate financial relief during a difficult time.

The Fine Print on Implementation

While the intent is straightforward, it’s important to note the timeline: this rule doesn’t take effect immediately. It applies to health plan years that begin on or after January 1, 2027. This gives health insurance providers and group plans time to adjust their billing systems, which is necessary since bundling payments is a complex accounting process. The low vagueness of the bill text suggests a clear directive for insurers, but it will require them to precisely define and track what “the cost-sharing amount that would have applied to the full bundled payment” actually means within their specific plan structures.