Does Medicare pay for pregnancy?

Plenty of people think only of seniors when they think of Medicare. They might even be surprised to learn that it can help cover costs associated with childbearing. But for women who receive social security benefits for disability, it’s important to know Medicare will help pay for the cost of their pregnancy.

For pregnancy-related expenses you get in a hospital, you need Medicare Part A hospital insurance. For doctors’ visits or outpatient services, you need Medicare Part B. If you’ve received disability payments for two years, you should be automatically enrolled in both parts. You will be asked to pay the hospital deductible for Part A and the copays for Part B services, depending on what treatments you receive. And if you have a Medicare Advantage Plan, you don’t need to worry about your coverage. Medicare Advantage Plans are required to cover everything Original Medicare covers.

Medicare asks that the surgeons and obstetricians you use bill your pregnancy expenses in one package. This package includes the cost of the surgery or delivery of the child, all prenatal, and all postnatal services. As with any service, Medicare will only cover it if all the physicians and hospitals involved in your care accept Medicare.

The Medicare Benefit Policy Manual describes its coverage of pregnancy as follows: “Skilled medical management is appropriate throughout the events of pregnancy, beginning with diagnosis of the condition, continuing through delivery, and ending after the necessary postnatal care.” Still, the promise to cover prenatal and postnatal care can seem vague. What services, exactly, will Medicare pay for? Below are some examples:

  • Laboratory testing
  • Genetic testing and counseling for congenital conditions
  • Treatment for miscarriage or pregnancy complications
  • Abortions, when the pregnancy endangers the life of the mother, or if a result of incest or rape.
  • All services associated with surgical procedure or delivery (this includes cesarean sections and epidurals)
  • A licensed midwife’s services, under select circumstances These are usually only covered if they provide services that would be covered by Medicare if performed by a physician; for a more complete list of requirements, consult with your doctor or midwife.

There are also a few services which Medicare may sometimes cover. There are no national or local coverage determinations for these services, so Medicare hasn’t decided yet whether to cover them. These services include:

  • Treatment of pre-term labor
  • In-utero surgery

Services Medicare will not cover

There are also common pregnancy-related expenses Medicare will not cover. Among these are

  • Testing solely for sex determination. This can include ultrasounds, amniocentesis, and chorionic villi sampling. However, these tests can be covered if they are meant to look for an infection or developmental abnormalities.
  • Childbirth classes
  • Blood testing for paternity
  • Elective sterilization after delivery
  • Self-administered medications. If you have a Medicare Part D Plan or a Medicare Advantage Plan, this may not apply to you.
  • The services of lactation specialists
  • Health care for the baby following birth

Pregnancy, though challenging, doesn’t have to be a financial catastrophe. For women who are disabled and pregnant, Medicare is a good option for covering the cost of childbirth.

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