Insights

The Average Cost of a Pediatrician Visit Without Insurance

Alexis Bryan27 Jul 2021

During the first year of life, pediatricians recommend 7 doctor visits to ensure your baby is growing and developing properly. The average cost of a pediatrician visit without insurance is around $100. Still, if you add in the price of immunizations and other out-of-pocket expenses, this can amount to over $3,000 in a single year. Well-baby visits are crucial, and unfortunately, can be extremely expensive without health insurance.

Average Cost of a Pediatrician Visit Without Insurance

The average cost of a pediatrician visit without insurance is around $100, but this does not include the additional fees incurred during these visits. BMO Harris Bank estimates the average total out-of-pocket medical expenses to be $1,297 during the first year of your baby’s life. This is in addition to pediatrician visits and immunizations.

Well-baby visits consist of a physical exam, measurements, development assessment, vaccines, and general care questioning. Additionally, some doctors will charge a new patient fee, and this is all assuming your baby is in perfect health. If your baby becomes ill, the price of care will likely increase. Below we outline some of the costs associated with pediatrician visits during the first year of life.

Average Costs During the First Year of Life

Type of VisitCost
Visit a hospital and Hep B vaccine$250
3-day well-visit$150
2-week well-visit and screening$500
4-month well-visit and DTaP, Hib, PCB, Rotavirus, and IPV immunizations$550
6-month well-visit and DTaP, Hep B, PCV, Hib, Rotavirus, and IPV immunizations$550
9-month well-visit and immunizations$550
12-month well-visit and MMR, Hepatitis A, Varicella, Hib, and PCV immunizations$550
TOTAL$3,100 without insurance

Importance of Pediatrician Visits

Pediatrician visits are important to manage and monitor the health of newborns. The pediatrician will check for abnormalities in the head, heart, lungs, organs, ear, mouth, and eyes. By keeping up with the appointments and immunizations, you can protect the health of your child.

Dr. Morgan Finkel, an academic pediatrician at Morgan Stanley Children’s Hospital, expands on the importance of well-baby visits, “Well baby checkups are vital to ensuring that infants are growing and developing appropriately and that all parental concerns are being addressed. In addition, the appointments are timed to ensure infants receive their primary vaccine series as early as possible to protect them from dangerous infectious diseases.” 

Ways to Reduce the Costs of a Pediatrician Visit

The average costs of pediatrician visits without insurance are quite high, but there are resources available to help you access more affordable care for your child. Below are some options for you and your family.

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Enroll Your Child in a Public Health Insurance Program

There are two assistance programs in every state to help low and middle-income families access free or low-cost healthcare coverage: Medicaid and Children's Health Insurance Program (CHIP). If your child is covered by one of these programs, you will need to make appointments with providers who accept patients enrolled in Medicaid/CHIP. 

  1. Medicaid eligibility includes children, pregnant women, those with a disability, and seniors dependent on income level. Kids are eligible for health insurance through Medicaid if they are U.S. citizens or lawfully admitted immigrants, even if their parents are not. Most states offer health insurance to all people with income below 133% of the Federal Poverty Level, equivalent to $17,130 per year for an individual or $35,245 for a family of four.
  2. Children's Health Insurance Program (CHIP) is a federally funded health insurance program, but the requirements vary from state to state. A child is eligible for CHIP based on their parent's income. You can see if you and your family qualify by applying through the Health Insurance Marketplace.

Find a Private Insurer that Offers Benefits

The Patient Protection and Affordable Care Act has prompted many private health insurance companies to benefit families with children. You can visit the Health Insurance Marketplace, submit an application, and find options available in your area. The Marketplace also allows you to compare benefits, copays, and deductibles for cost transparency.

Visit a Local Community Health Center

Many community health centers use federal funds to provide low-cost care to families with children. The price is determined by your income on a sliding scale and can even be free. Oftentimes they offer check-ups, immunizations, and sick care for pregnant women and children. By visiting a local community center, you can avoid health insurance premiums altogether.

You can enter your zip code on the Department of Health & Human Services (DHHS) website to find a health center near you. The website will also help you determine the clinic's hours, services offered, and potential costs.

Health Insurance Alternatives

Another way to avoid health insurance is to enroll in a health insurance alternative, like Mira. Mira can help save you money through discounted prescriptions, affordable gym memberships, and low copay urgent care and lab tests. Since the average cost of a pediatrician visit without insurance is expensive yet crucial, many parents look elsewhere to save in other areas of their health care.

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Periodicity Schedule

The American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines titled Recommendations for Preventive Pediatric Health Care, known as the “Periodicity Schedule.” It is a general schedule of recommended screenings from infancy through adolescence. Below is a sample portion of the schedule.

Average Cost of a Pediatrician Visit Without Insurance Frequently Asked Questions (FAQs)

Caring for your baby can be stressful and expensive without insurance. Here we answer a few commonly asked questions so that you can properly care for your infant over the first year of life.

How often should I take my newborn to the doctor?

Pediatrician appointments for your baby are scheduled 2-5 days after birth, and then at one, two, four, six, nine, and twelve months for optimal care. After year one, the American Academy of Pediatrics recommends at least nine checkups during the first three years of life. Each one of these visits has various screenings and assessments depending on the age of your child. It is important to follow the schedule as closely as possible to promote the maximum health of your baby.

Why are well-baby visits important?

Well-baby visits are important to ensure your baby is healthy and growing properly. Pediatricians will evaluate the health and development of your child at each visit through a series of screenings. They will also administer essential immunizations to protect their health in the future. Additionally, your pediatrician can help inform you of proper nutrition practices and discuss milestones, social behavior, and learning. Any concerns you may have regarding your child can be addressed during a well-baby visit.

How can I access affordable care for my child?

There are two common governmental assistance programs to access affordable health insurance for your child: Medicaid and CHIP. Both of these programs have specific eligibility requirements and can vary by state. You can also apply on the Health Insurance Marketplace to see available private plans near you that offer similar benefits. Aside from health insurance options, community health centers offer sliding scale services for pregnant women and children. Lastly, alternatives to health insurance, including Mira, can help you reduce health care spending in other areas of your life.

How do I choose a pediatrician?

Pediatricians are doctors who have graduated from medical school and completed three years of residency in pediatrics. Parents often choose their preferred pediatrician before their baby is even born. Good pediatrician recommendations usually come from people you trust. Talk to friends and family to see if people you know use a particular practice. Ensure to search reviews of the physician before scheduling an appointment, or call and ask to interview before scheduling. It is also important to consider the price of their services, and if you have insurance, if they accept it.

Bottom Line

The cost of pediatrician visits without insurance can add up over time, especially with all associated fees. To minimize your spending on prescription drugs or urgent care you may need, Mira offers exclusive discounts and copays to members. For $45 per month, you can visit your local pharmacy or urgent care center without worrying about surprise medical bills.