Does Medicare Cover Pregnancy and Child Delivery?
This article was updated on: 09/10/2018
Yes, Medicare does cover certain services related to pregnancy and delivery in some situations. This isn’t too surprising when you consider that Medicare beneficiaries include those younger than age 65 who qualify because of disability. According to a 2017 report from the Centers for Medicare & Medicaid Services (CMS), about 9 million Medicare beneficiaries (or about 16% of all Medicare recipients) qualify for Medicare because of disability.
About Medicare and pregnancy coverage
If you or a loved one falls within this category of Medicare beneficiaries who are of child-bearing age, you may be wondering “What does Medicare may cover during pregnancy and child delivery?” As explained in the CMS Medicare Benefit Policy Manual, Medicare may cover “reasonable and necessary” skilled medical care “throughout the events of pregnancy, beginning with the diagnosis of the condition, continuing through delivery, and ending after the necessary postnatal care.”
If you are pregnant or planning a pregnancy, your doctor may be your best source for advice on prenatal care, a safe delivery, and proper care after you give birth. Make sure your doctor accepts Medicare assignment, or you might have to pay more for your health-care services.
Your prenatal care might include services such as regularly scheduled visits to the doctor, certain vaccines such as seasonal flu shots, screenings for certain diseases that could be harmful to you or your unborn child, and nutrition counseling, according to the Department of Health and Human Services.
What does Medicare cover for pregnancy and delivery?
Medicare Part B may help cover the cost of these medical services provided in your doctor’s office or ordered by your doctor and provided in a clinic or outpatient setting. Once you have met your Medicare Part B deductible, Medicare will usually pay 80% of the cost of prenatal and post-partum (after birth) medical care. You will typically pay 20% of the Medicare approved amount for these services. Medicare does not cover your infant after delivery.
Medicare Part A may cover inpatient hospital services, including the delivery of your infant and your hospital stay. Once you have met your Medicare Part A deductible, Medicare will usually pay 80% of the Medicare approved amount for hospital services and you typically pay 20% of the Medicare approved amount.
Medicare may also help pay the cost of pregnancy-related care. Medicare coverage may extend to the treatment you receive if you have a miscarriage, generally paying 80% of the Medicare-approved cost after you have met your annual deductible. Medicare coverage is available for abortions in circumstances under which pregnancy is the consequence of incest or rape or poses a serious threat to your life if you were to carry your unborn child to term. Medicare does not cover elective abortions if you choose to terminate your pregnancy for other reasons.
What if Medicare does not cover all the costs of pregnancy and child delivery?
If you need help paying for the portion of your medical care that Medicare does not cover, resources may be available to help you. You might be eligible to enroll yourself and/or your newborn in Medicaid. To learn more, contact your state Medicaid agency.
If you’d like more information about Medicare plan options and possible coverage of pregnancy, I’d be happy to answer your questions. You can request a phone call or an email with information by clicking the appropriate link below. To see a list of plans in your area you may qualify for, click the Compare Plans button below.