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Does Medicare Cover Pregnancy?

Does Medicare cover pregnancy? It may seem like a surprising question because Medicare’s main purpose is to provide health insurance for senior citizens age 65 and over, but Medicare also provides health care benefits for people of any age who have permanent disabilities or end-stage renal disease.

There are over one million female Medicare recipients who are under the age of 65 and they are entitled to Medicare Part A and Part B benefits that cover pregnancy.

Does Medicare Cover Pregnancy?

If you are in childbearing age, between 18 and 44, and have Medicare coverage, you may be wondering about Medicare coverage for services during pregnancy.

There is no doubt that pregnancy involves a lot of expensive health care services. There are six main components to health care services during pregnancy:

1. Diagnosis

2. Prenatal care

3. Lab testing

4. Genetic testing

5. Delivery/childbirth

6. Postnatal care

While every pregnancy is different, these are the common services and tests that doctors prescribe for pregnant women.

Prenatal and postnatal care:

Medicare Part B covers all doctors’ visits and other outpatient services and tests related to pregnancy, including diagnosis, prenatal care, and postnatal care. As part of prenatal care, women see their obstetrician for regular checkups during the pregnancy, with the frequency increasing in the last few weeks. At each routine office visit, the OBGYN checks blood pressure and weight and, after week 22, measures the size and shape of the uterus. Various tests may be ordered throughout the pregnancy to ensure the health of the fetus and mother, including:

  • Blood tests on the mother

  • Amniocentesis

  • Chronic villus sampling (CVS)

  • Ultrasounds

Many pregnant women are also prescribed precautionary vaccinations and prenatal vitamins and supplements.

Postnatal care includes a health check-up for the mother at six weeks postpartum.

Depending on the type of treatments you receive, you are responsible for Part B copayments or coinsurance.

Hospital care:

All pregnancy-related care that Medicare beneficiaries receive when they are formally admitted into the hospital is covered by Original Medicare Part A hospital insurance. You must pay your hospital deductible for Part A services.

Prescription drugs and supplements:

Original Medicare doesn’t cover prescription drugs but Medicare Part B may cover certain vitamins and supplements if your doctor prescribes them as part of your treatment plan. Check with your health care provider about which supplements are covered by Part B.

If you have a Medicare Advantage plan (Part C), you may have additional pregnancy coverage. Another advantage to Part C plans is that they come with an annual out-of-pocket spending limit, which Original Medicare doesn’t offer. When you consider how expensive it is to have a baby in the U.S., it’s very important to have good health insurance to help cover the costs.

While Medicare covers most of the costs of pregnancy, it may not cover elective pregnancy related expenses such as:

  • Childbirth classes

  • Paternity blood tests

  • Elective sterilization post-delivery

  • Lactation specialists

It’s also important to understand that once your baby is born, they are treated as a separate individual, and their health care is not covered by Medicare.

Speak to your insurance provider or Medicare agent about any specific coverage questions. If you have questions about Medicare coverage, we are here to help!

Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. We are the only insurance agency in Hawaii contracted with EVERY Medicare Advantage plan, which means we are able to offer unbiased advice; all at no cost to our clients.

At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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