Objective: The paper attempts to evaluate the temporal changes in maternity healthcare service utilization and costs, to identify population disparities in the associated financial burden, and to offer evidence for refining maternity healthcare cost coverage policies. Methods: A retrospective collection of regional cost coverage policies for maternity expenses, along with data on the utilization and costs of prenatal check-ups and inpatient delivery services among women of reproductive age since 2015, was conducted. Linear interpolation and extrapolation methods were employed to estimate prenatal check-up medical expenses. The utilization and costs of delivery services were analyzed using the Diagnosis-Related Groups framework. By integrating data on household consumption expenditures, the out-of-pocket burden of medical expenses for different populations and types of healthcare institutions was assessed. Results: Both the breadth and depth of maternity healthcare service utilization in the sample regions continued to increase, with maternity medical costs showing a steady upward trend. The out-of-pocket share for prenatal check-up costs among insured employees was approximately 79%, while for cesarean deliveries in secondary and tertiary public hospitals, the out-of-pocket share was about 49% and 58%, respectively. The healthcare security level of maternity insurance for maternity medical expenses requires further enhancement. Conclusion: Timely adjustments should be made to the reimbursement standards for prenatal check-ups, and a cost guarantee coordination mechanism should be established to enhance the medical insurance benefits for insured individuals during their pregnancy. Hospital delivery costs should be incorporated into the Diagnosis-Related Groups payment system to encourage hospitals to improve the management level of maternity medical services and costs. The maternity medical expense guarantee policies for flexible employees and unemployed individuals should be improved, with categorized measures implemented to ensure basic security.