Does Medicare Cover Abortion?

Medicare Benefits Solutions
Dec 25, 2020

Abortion is a deeply personal choice, and although it is often considered a last resort, the procedure is currently an option available to women in the United States. Due to biological considerations, older women typically do not concern themselves with whether or not Medicare covers abortion, but Medicare provides benefits to qualifying adult women for a variety of reasons, so women of childbearing age who are Medicare recipients may also be curious to know if Medicare covers abortion.

Does Medicare Cover Abortion?

Medicare does not cover abortion unless the procedure is medically necessary to preserve the life of the mother or in cases where the pregnancy is the result of rape or incest. The medical necessity requirement follows along with many other Medicare-covered services as the program is intended to provide benefits only for procedures and medical services that are needed to preserve life and treat disease. As a result, cosmetic surgery is not covered, and this means that elective procedures, including elective abortion, are not covered by Medicare.

If an abortion procedure is covered by Medicare, services would be provided under Part B, the outpatient benefit. If hospitalization is required before or after the procedure, Medicare’s Part A inpatient benefit would supply benefits. Prescription medications that are purchased from a retail pharmacy to aid in recovery after an abortion with complications would be covered by Part D. Any covered medications will need to be listed in your plan’s formulary or an exemption will need to be filed and approved to obtain coverage for unlisted medications.

Does Medicare Cover Family Planning Options?

If you’re a Medicare recipient who is concerned about the risk of an unplanned pregnancy, you might want to consider family planning options like oral birth control and other contraceptives. Original Medicare may provide coverage for prescription contraceptives through Part D, but once again, you will need to consult with your plan’s formulary to ensure that your particular medication or method of administration is covered. In some cases, contraceptives are administered via an injection or they may be provided through the use of an intrauterine device. In cases where birth control is administered outside of a medication that you take at home, Medicare Part B would apply toward coverage.

In terms of non-prescription birth control options, Medicare does not offer coverage for over-the-counter products like condoms. If you purchase these products, you will be responsible for the full cost and will not be able to submit a claim for reimbursement. A Medicare Advantage plan, however, may provide additional coverage for or discounts on these types of products. Because each plan is different, you will want to review your plan’s details and speak with your plan manager to know exactly what your coverage options provide.

Abortion Laws May Differ

Recipients of Medicare coverage should also be aware that different states have different laws regarding abortion services available. This means that even though an abortion procedure may be covered by Medicare, it may not be available in your state. Work closely with your doctor to find the right options for your potential healthcare needs in your state should a difficult decision need to be made.