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(NerdWallet) – It takes an emotional and physical toll when you experience pregnancy loss — and it can also bring an unexpected financial burden.

Even with insurance, surgical treatment for a miscarriage can add up to more than $4,300 on average, according to FAIR Health — a national, independent nonprofit that uses health care claims data to provide cost estimates to consumers.

How much of that you pay depends on your insurance plan.

What is a miscarriage?

Miscarriage is the most common form of pregnancy loss, according to the American College of Obstetricians and Gynecologists. A miscarriage occurs when there is a spontaneous loss of the embryo or fetus in the womb during the first 20 weeks of pregnancy. Studies indicate roughly 1 in 4 pregnancies end in miscarriage, with the majority occurring during the first trimester.

After a miscarriage, the body needs to shed the contents of the uterus. This may happen naturally and last a few weeks. But it also could require taking medication or undergoing minor surgery called dilation and curettage, or D&C, to ensure all the remaining tissue is removed.

The Cleveland Clinic provides more detail on the signs and types of miscarriage. If you’re pregnant and experience any of the symptoms described, contact your physician.

Miscarriage and the cost of a D&C procedure

Costs really go up when a person needs a D&C after a miscarriage. FAIR Health data shows the average cost of a D&C during the first trimester is $4,307 with insurance; a D&C used to treat a second-trimester miscarriage is $5,301 on average. These costs include outpatient facility and physician fees, which may be higher or lower depending on where you’re treated.

Your share of the bill would be determined by your plan’s coinsurance or copayment policies, as well as your deductible and out-of-pocket maximums.

For someone who isn’t insured, FAIR Health data shows the cost almost doubles to $8,445 for a first-trimester procedure and to $9,742 during the second trimester.

State Medicaid programs also cover treatment for miscarriage. Medicaid provides coverage to people who are pregnant and who meet eligibility requirements. Pregnancy-related care provided under Medicaid includes services needed to care for the pregnant person and their unborn baby. This includes medical services that become necessary because the person was pregnant, like a D&C. The national program pays for roughly 40% of births in the U.S., according to KFF, a health research group.

A person who qualifies for Medicaid because they are pregnant remains eligible for at least 60 days after the pregnancy ends, allowing for continued care during the postpartum period, including after pregnancy loss. And under the American Rescue Plan Act of 2021, state Medicaid programs can extend the postpartum coverage period to 12 months. As of last month, 34 states had implemented or planned to implement that extension.

Contact your state Medicaid office to determine what is covered where you live.

Miscarriage and the cost of medication

A surgical procedure may not be necessary in all cases of miscarriage, with medication being a less invasive and cheaper option. The most likely drug to be prescribed is misoprostol. Studies show adding a second medication — mifepristone, which is taken before misoprostol — can be more effective than taking misoprostol alone. This would make it less likely that a person who has experienced a miscarriage would require additional medical intervention like a D&C.

Since pregnancy care is an essential health benefit under the Affordable Care Act, most insurance plans and Medicaid are required to cover medication used to treat a miscarriage. However, mifepristone and misoprostol also are used in abortions, which has impacted access in some states.

On average, treating a miscarriage with medication costs just under $700, whether you take one or both drugs, according to a 2018 study published by the American Medical Association.

How the recent Roe v. Wade decision impacts miscarriage

The overturning of Roe v. Wade by the U.S. Supreme Court allowed states to enact laws banning or severely restricting abortion. These state laws can also impact people experiencing pregnancy loss since treatment for miscarriage often depends on the same medications and the same surgical procedures that are used to induce an abortion and clear tissue from the uterus.

The impact could be felt through insurance coverage as well as access to care.

A Texas abortion law enacted in 2021 allows civil actions to be brought against anyone who assists with ending a pregnancy after six weeks, resulting in at least a $10,000 fine. As a result, there have been reports detailing stories of patients who struggle to get care after a miscarriage because doctors or pharmacists are trying to avoid any appearance of assisting an abortion.

Access challenges could impact cost if patients are forced to pay for services themselves, either because coverage is denied or they’re forced to seek care at facilities outside their insurance plan’s network. Delays in administering medication after a miscarriage could also result in the need for additional medical care.

This July, the Biden administration warned pharmacists that they can’t refuse to fill prescriptions for medications used in abortions because those drugs have other approved uses.