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Does Medicare Cover Pregnancy?

Q. I’m on Medicare because of disability, and I’m pregnant. Does Medicare cover pregnancy and childbirth?

A. Yes, it does. Most people on Medicare are age 65 and older so the program isn’t usually associated with childbearing, but many younger people who receive Social Security disability benefits also qualify for Medicare coverage, and some of them do indeed become pregnant.

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The relevant regulation (as set out in the Medicare Benefit Policy Manual, Chapter 1, section 80) explains: “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.”

Medicare also covers the cost of treatment for miscarriages, and for abortions in circumstances where the pregnancy is the result of incest or rape or would threaten your life if you went to term. It doesn’t cover elective abortion if you choose to terminate your pregnancy.

This coverage for pregnancy, childbirth, or termination is just the same whether you’re enrolled in the traditional Medicare program or a private Medicare Advantage health plan. The private plans must provide all Medicare-covered services.

Although you continue to be covered for postnatal care after your child is born, any treatment or services the infant needs are not covered under Medicare.

To receive coverage for hospital services, you must have Medicare Part A hospital insurance, which Social Security enrolls you in automatically after you’ve collected disability payments for two years. For coverage for doctors’ visits and other outpatient services, you need to be enrolled in Part B. You pay the regular Part A hospital deductible and Part B copays for outpatient care.

If you’re also enrolled in Medicaid, the federal-state health care program for certain groups of low-income people (including pregnant women), that program may pay the Medicare hospital deductible and copays for you—although those benefits vary according to the state you live in and your income level. Medicaid will also pay health care costs for your children if your income is within your state’s eligibility limits. For more information on Medicare, go to this site and use the pull-down menu to select an organization and click on “State Medical Assistance Office,” then select the name of your state. To call your state medical assistance office, look for the number in the state pages of your telephone book.

Patricia Barry is a senior editor at the AARP Bulletin.

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