Does Medicare Cover Pregnancy?

Medicare typically does cover pregnancy at all stages throughout the pregnancy, from diagnosis, through childbirth and through some postnatal care.

The Part of Original Medicare (Part A or Part B) that covers your pregnancy care will depend on the type of facility in which you undergo delivery and other childbirth-related services.

Medicare Advantage (Part C) plans may also cover pregnancy care that would be covered by Original Medicare. They also include an annual out-of-pocket spending limit, which Original Medicare doesn’t offer.

A nurse smiles in a hospital room

Why does Medicare cover pregnancy?

Medicare offers coverage to qualified Americans age 65 and older, but some people may also be eligible for Medicare under 65 due to a qualifying disability or condition.

If someone is eligible for Medicare under 65, their pregnancy and childbirth care could potentially be covered by Medicare.

What childbirth care does Medicare cover?

Medicare may provide coverage at all stages of pregnancy, including:

  • Beginning diagnosis
  • Prenatal care
  • Lab testing
  • Genetic testing
  • Delivery/childbirth
  • Postnatal care

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 the pregnancy are typically covered by Medicare Part A (hospital insurance).

  • Any doctor’s services related to the pregnancy are typically covered by Medicare Part B (medical insurance).

Medicare typically also covers certain screening services for pregnant beneficiaries if they are ordered by a doctor:

  • Hepatitis B Virus (HBV) infection screening
    • At the first prenatal visit for a pregnancy
    • At the time of delivery, if you have new or continued Hepatitis B risk factors
  • Human Immunodeficiency Virus (HIV) screening
    • Up to three screenings during a pregnancy
  • Sexually transmitted infection (STI) screening/counseling
    • Once every twelve months or at certain times during a pregnancy

Medicare may not cover all pregnancy related expenses such as:

  • Elective ultrasounds
  • Childbirth classes
  • Paternity blood tests
  • Elective sterilization post-delivery
  • Lactation specialists

Once your baby is born, they are treated as a separate individual, and their health care is not covered by Medicare based on your Medicare eligibility.

How much does pregnancy cost with Medicare?

Even if Medicare covers your pregnancy, there are some out-of-pocket costs you should expect to pay, which may include:

  • Part A deductible
    The Medicare Part A deductible is $1,364 per benefit period in 2019.

The Part A deductible is not annual. You could experience more than one benefit period in a given calendar year.

  • Part A coinsurance
    After you meet your Part A deductible in a benefit period, you could face Part A coinsurance costs if you remain admitted in the hospital for inpatient care for longer than 60 days. This is uncommon in most pregnancies.

  • Part B deductible
    The Medicare Part B deductible is $185 per year in 2019.

  • Part B coinsurance or copayment
    After your Part B deductible is met, you typically pay 20 percent of the Medicare-approved amount for most doctor’s services.

There is no annual limit on how much you could pay for the Part B coinsurance in a given year.

We recommend speaking with your doctor directly for specific cost and coverage information.

Medicare Advantage plans can cover more costs

Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare.

Every Medicare Advantage plan must cover everything that Part A and Part B covers. If your pregnancy is covered by Original Medicare, it will also be covered by a Medicare Advantage plan.

Some Medicare Advantage plans also offer additional benefits, such as:

A licensed insurance agent can help you learn more about the Medicare Advantage plans that are available where you live.

 

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