Since 2005, Nepal government has implemented Maternity Incentive Scheme (MIS) to reduce out-of-pocket expenditure (OOPs) for institutional birth. This study aimed to assess MIS coverage in Nepal and OOPs among women who had institutional births. Findings showed that 96.5 % of the women enrolled in the study were covered under the MIS, while the average OOPs per birth was 41.5 USD, of which 36 % accounted for transportation cost. In addition, the OOPs was varied by mode of delivery, duration of hospital-stay, and hospital of birth.