Does Medicare cover pregnancy-related medical costs?

By Medicare Benefits - September 28, 2020

Hear someone mention Medicare, and the first thing that typically comes to mind is retirement. Medicare information across the web can often be channeled to seniors approaching 65 years of age or older, but millions of people qualify for Medicare under the age of 65 due to certain disabilities, many of whom may be in their reproductive years. If you’re on Medicare and planning to expand your family, you may need to understand Medicare’s coverage of pregnancy related care.

Qualifying for Medicare under the age of 65

If you are younger than 65, you are eligible for Medicare benefits if one of the following scenarios apply: 

  • You received a diagnosis of end-stage renal disease (ESRD).
  • You were diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease.
  • You have been receiving Social Security Disability Insurance (SSDI) for 24 months.

The conventional qualification for Social Security benefits hinges on credits earned through employment. Most people are required to have banked 40 credits over a lifetime of working. However, in the case of disability and survivor benefits, this requirement may not apply.

In the scenarios listed above, enrollment in Part A and Part B is automatic. There is an exception for Puerto Rico residents. If you live in Puerto Rico, your coverage for Part A is automatic, but you need to sign up for Part B. 

Medicare benefits during pregnancy
In the same way Medicare recipients age 65 and over receive benefits under Part A and Part B, your pregnancy-related medical costs also apply. Part A covers inpatient care in the hospital, and Part B covers visits to your doctor and outpatient care. Postnatal care is covered as well, but medical services for your newborn are not covered under Medicare. 

The 2020 deductible for Part A is $1,408 with $0 coinsurance as long as the hospital stay does not exceed 60 days. The deductible for Part B in 2020 is $198. Once you have reached the Part B deductible, your responsibility is 20% of the Medicare-approved charges for most of the services provided by your doctor, including the doctor's care while you are in the hospital.  

Resources
If you are pregnant and have limited income, you may be eligible for Medicaid. Medicaid helps provide health insurance to millions of people who qualify due to low income. It is administered by the states, but must follow federal regulations. Visit medicaid.gov to learn more.

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