Does Medicare Cover Pregnancy?

Is it possible for Medicare to cover pregnancy, especially since most of their beneficiaries are at an age that is not associated with childbearing? Though Medicare is primarily for people who are 65 and older, it is also for people who have disabilities. So what if the Medicare recipient is female, under the age of 65, and is pregnant?

Or, to put it another way, “does Medicare cover pregnancy?” In this article, we answer that question in clear, plain English. You will also find the average costs of services related to pregnancy and other helpful info.

The short answer is yes; Medicare will cover the cost of medical services and care for pregnancy. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your pregnancy and childbirth services. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for medical services and care related to your pregnancy as well as childbirth. Parts A and B cover pregnancy care and services at all stages from diagnosis to childbirth to even some postnatal care.

The part of Original Medicare that will provide coverage for the expenses of your pregnancy-related care and services will depend if it is inpatient or outpatient. Medicare provides coverage for the following services and cares for pregnancy:

Diagnosis
Vitamins and supplements ordered by your healthcare provider
Prenatal care
Lab tests
Genetic tests
Delivery of the child
Postnatal care

Some screening services for pregnant beneficiaries are also covered by Medicare. These screening services consist of:

Hepatitis B screening for prenatal and during delivery
3 HIV screenings during pregnancy
STI screening

However, Medicare will not cover all the costs of pregnancy-related services, especially if they are not medically necessary. Some of these services include the following:

Paternity blood test
Elective ultrasound
Childbirth classes
Elective sterilization post-delivery
Lactation specialists

Once the child is delivered, he/she will be treated as a different individual and will not be covered by his/her parent’s eligibility.

Coverage for hospital-based pregnancy services and care is provided by Medicare Part A. Medical Part A is the portion of Original Medicare that covers the costs of hospital and inpatient services and care.

Coverage for doctor’s visits and outpatient services for pregnancy is provided by Medicare Part B. Medicare Part B covers 80 percent of the costs associated with your pregnancy. You will pay for the remaining 20 percent.

Part C Coverage for Pregnancy

Medicare Advantage plans (Medicare Part C) also provide coverage for pregnancy-related services. They cover everything Original Medicare covers, but usually will also provide additional benefits. However, exactly what it covers and how much your out-of-pocket costs are will vary depending on the specifics of your plan.

How Much Do Pregnancy Services Cost?

Pregnancy services and care can be very expensive and can cost you up to a total of $11,000 for traditional delivery along with checkups, tests, and prenatal care. Undergoing a Cesarean section for childbirth is more expensive and can cost you $14,500.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.