Does Medicare Cover Pregnancy? 

In the United States, over nine million people under the age of 65 with disabilities are enrolled in Medicare. You may qualify for Medicare insurance benefits before the age of 65 if any of the following conditions apply:

• You have been receiving Social Security Disability Insurance (SSDI) for at least 24 months due to a qualifying disability. 
• You have end-stage renal disease. 
• You have Lou Gehrig’s disease (ALS).

People diagnosed with end-stage renal disease or Lou Gehrig’s disease will start getting Medicare coverage immediately.  

If you qualify for Medicare insurance before age 65 and you become pregnant while enrolled, your coverage includes many health care services you’ll need during your pregnancy. 

How does Medicare cover pregnancy? 

Medicare covers health care services associated with every phase of pregnancy from your initial diagnosis to postnatal care, whether you’re enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance), or a Medicare Advantage (Part C) plan. 

Original Medicare Part Bcovers 100 percent of the cost of the following pregnancy care services:

• Medically necessary clinical diagnostic laboratory tests that are ordered by a health care provider who accepts Medicare assignment. These tests include blood and urinalysis tests, tissue specimen tests, and certain screening tests. 

Original Medicare Part B covers 80 percent of the final approved cost of the following medical care services:

• Regular obstetrician visits for prenatal care during your pregnancy. This includes one visit every four weeks for the first 28 weeks, one visit every two weeks for weeks 28 to 36, and one visit every week from week 36 until delivery. 
• Outpatient services and tests that aren’t considered diagnostic laboratory tests, such as pap smears, breast exams, ultrasounds, genetic counseling, etc. 

For the above-listed services, you pay 20 percent after covering your Part B deductible for the year. If you receive medical services in a hospital outpatient setting, you may also be responsible for a copayment to the facility. 

Original Medicare Part Acovers 100 percent of the cost for your delivery and postnatal care in a hospital that accepts Medicare assignment, and after you pay the Part A deductible for the current benefit period. 

Medicare Part A coverage doesn’t include private-duty nurses, a private room (unless your physician certifies that one is medically necessary), television, phone, or personal care items. 

Medicare Part D, or Medicare prescription drug plans cover most medications that are commonly prescribed for prenatal and postnatal care. If you’re a beneficiary of Original Medicare, you can enroll in a stand-alone Medicare Part D plan. If you choose to enroll in a Medicare Advantage plan, you can choose one that includes prescription drug coverage. 

Does Medicare Advantage cover pregnancy-related care?

Medicare Advantage (Part C)plans must cover, at minimum, all the benefits that Original Medicare Parts A and B do. Most Part C plans include extra benefits, so you may have access to more coverage regarding your pregnancy health care services. 

Depending on the kind of Medicare Advantage plan you have, you might need to use physicians, obstetricians, hospitals, clinics, laboratories, and other medical facilities that your plan includes in its network of approved providers. You may also have different copayment and coinsurance charges, too. 

If you aren’t sure what your MA plan covers, or what your network restrictions are, you should contact the plan provider for detailed information before making medical appointments to ensure that your services are covered.