Medicare is a government-run health insurance program that provides coverage for Americans over the age of 65. It also covers some younger people with disabilities. Does Medicare pay for pregnancy? The answer to that question is a little complicated, but we’ll break it down for you in this article.

It would seem like this would not be a common question for most people since Medicare is primarily for people 65 and older. Still, the fact is that there are more than one million females on Medicare that are between the ages of 18 and 44 who could still become pregnant.

Medicare Coverage for Pregnancy

Medicare covers pregnancy under Parts A and B. Pregnancy is a time when women have to deal with a variety of health care services, and there are certain standard treatments and examinations that obstetricians usually provide to every pregnant woman.

Some of the most frequent obstetrician-attended health care treatments throughout pregnancy include prenatal checkups for the mother. These include regular appointments with an obstetrician.

Visits are scheduled once every four weeks during the first 28 weeks. After week 28 and up to delivery, visits become more frequent: twice a week until week 36, then weekly until delivery.

The doctor checks your blood pressure and weight at each appointment. The size and form of the uterus are measured after 22 weeks.

If required, the doctor may order prenatal tests on rare occasions throughout this 40-week gestational period. The following are a few examples of routine prenatal testing, including blood tests on the mother to check for blood type, anemia, gestational diabetes, immunities, and possible STDs.

Additional testing may include Amniocentesis to determine specific conditions like Down syndrome, Trisomy 21, or to check fetal lung maturity.

Further testing could include chronic villus sampling (CVS). This prenatal test detects birth defects, genetic diseases, and other problems during pregnancy.

Ultrasound examinations are standard during all pregnancies. Your doctor may also prescribe precautionary vaccinations and prenatal vitamins and supplements.

Healthcare services covered by Medicare for Pregnancy

The most essential services that Medicare covers for pregnancy are maternity care, prenatal care, postnatal care, and delivery. These are the standard services that every woman who is pregnant should receive.

However, there are other services that Medicare covers as well. Services include pap smear tests, breast exams, ultrasounds, and genetic counseling.

It’s important to note that while Medicare does cover these things, there may be some out-of-pocket costs associated with them. For example, you may have to pay a deductible or copayment for some of these services.

Depending on where you undergo your delivery and general care, Medicare Part A or Part B may cover some of your costs.

The hospital and inpatient care costs related to pregnancy are usually covered by Medicare Part A. Doctor’s services related to the pregnancy generally are covered by Medicare Part B.

Additional Medicare Coverage for Pregnancy

Medicare typically also covers certain screening services for pregnant beneficiaries if ordered by a doctor, such as Hepatitis B virus infection screening at the first prenatal visit for pregnancy and at the time of delivery.

If you have new or continued Hepatitis B risk factors, Human Immunodeficiency Virus (HIV) screening to three screenings during pregnancy, and Sexually transmitted infection (STI) screening and counseling once every twelve months or at certain times during a pregnancy.

Services that Medicare Doesn’t Cover for Pregnancy

Medicare does not cover abortions, fertility treatments, and elective procedures like cosmetic surgery.

Medicare covers abortions in the event of impendence to a woman’s life, incest, or rape. Or when there is a substantial risk that carrying your unborn child to term would result in death.

Services that May Not be Covered by Medicare for Pregnancy

Some services that may not be covered during pregnancy include elective ultrasounds, childbirth classes, and paternity blood tests. Post-delivery services not covered may include elective sterilization and lactation specialists.

Once your baby is born, they are a separate individual. Medicare does not cover their health care based on your Medicare eligibility.

Pregnancy Costs with Medicare

Even if Medicare covers your pregnancy, there are some out-of-pocket costs you should expect to pay, including Part A deductible, Part A coinsurance, Part B deductible, Part B coinsurance, or copayment.

There is no annual limit on how much you could pay for Medicare costs in a given year.

Enrolling in a Medicare Supplement plan will add protection to help pay for your portion of the Medicare costs.

Pregnancy Cost with Medicare Advantage

If you’re in a Medicare Advantage plan, your costs may differ. Many Medicare Advantage Plans offer additional benefits that original Medicare doesn’t cover. Some Medicare Advantage plans may also provide maternity coverage.

Medicare Advantage plans will provide you with a maximum out-of-pocket dollar amount. That is the most you will pay for your share of expenses in a given year.

FAQs

Does Medicare cover all my prenatal care?

Yes, Medicare will typically cover all of your prenatal care.

What will I have to pay for out-of-pocket if I’m pregnant?

You may have to pay a deductible or copayment for some services. There is no annual limit on how much you could pay for Medicare costs in a given year.

Does Medicare cover the delivery of my baby?

Yes, Medicare will typically cover the delivery of your baby. However, this service may have some out-of-pocket costs.

Does Medicare cover postnatal care?

Yes, Medicare will typically cover postnatal care, and there may be some out-of-pocket costs when receiving this service.

Does a Medicare Advantage plan offer maternity coverage?

Some Medicare Advantage Plans may offer maternity coverage. You’ll need to check with your specific plan to see if this benefit is provided.

If you’re pregnant and have Medicare, you can rest assured that your coverage will help pay for many of the care services related to your pregnancy. There may be some out-of-pocket costs with this service.

If you enroll in a Medicare Advantage plan, your costs may be different. Some Medicare Advantage plans may also offer maternity coverage. You’ll need to check with your specific plan to see if this benefit is provided.

Need Help Finding the Medicare Plan for you?

It’s important to know what Medicare will and won’t cover for pregnancy to plan and budget accordingly. Our licensed insurance agents can help you better understand what you can expect.

A Medigap plan could help you close the gap between what Original Medicare will cover and what your remaining costs are.

For more information, give us a call today. Or fill out our online request form to get the best rates in your area.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.