Does Medicare Cover a C-Section?

Most Medicare beneficiaries are over the age of 65 but there are over nine million Medicare recipients under 65 who also qualify for coverage due to certain permanent disabilities. Out of these nine million younger beneficiaries, one million are women between the ages of 18 and 44, the typical childbearing age group in the United States. 

Today in the United States, C-sections account for 32 percent of all births, and over 18 percent of them are emergency or unscheduled C-sections. If you have Medicare coverage and are pregnant, or caring for someone who is, you might be concerned about whether Medicare benefits include coverage for a C-section. 

Does Medicare coverage include C-sections?

With every pregnancy, there is a risk of complications and the possibility of needing a C-section. Your physician might call for an emergency cesarean if you or the baby is in distress, the umbilical cord is prolapsed, you are hemorrhaging, or there are problems with the placenta or uterus. An unplanned cesarean could occur if labor isn’t progressing, contractions are not strong enough, the baby is suffering from prolonged labor, or if the baby isn’t in the right position when labor starts. 

Under these urgent circumstances when a C-section is medically necessary and you are admitted to a hospital that accepts Medicare assignment, you have coverage through Original Medicare Part A (hospital insurance). 

While you are in the hospital as an inpatient, your Part A Medicare coverage includes the following hospital services:

• A semi-private room and meals
• General nursing care
• Prescription drugs that are part of your treatment as an inpatient
• Other miscellaneous services and supplies needed for your treatment

Part A coverage doesn’t include the following:

• Private nursing care
• A private room unless it is considered medically necessary
• Television or phone in your room unless these services are included in the room rate
• Personal care items 

When you receive care through your Original Medicare Part A benefits, you are responsible for paying the following charges:

• The Part A deductible, which is $1,484.00 in 2021, for each benefit period.
• $0 coinsurance for days 1 – 60 of each benefit period.

If your inpatient care exceeds 60 days, you must pay the coinciding coinsurance per benefit period. If you have a Medicare Supplement plan you may have coverage for the Part A deductible and coinsurance. 

While you are under inpatient care, the services you receive from your physicians must be covered by your Original Medicare Part B (medical insurance) benefits. Medicare Part B pays for 80 percent of the approved cost of services and you pay the remaining 20 percent. You are also responsible for your Part B deductible, which is $203.00 in 2021, and your monthly Part B premium which is $148.50 as of 2021. 

As of 2020, Medigap plans don’t offer coverage for the Part B deductible to new enrollees. However, if you have a Medicare Supplement or Medigap, you may have coverage for the Part B coinsurance of 20 percent. 

If you have a Medicare Advantage (Part C) plan through a private insurance provider, your plan must at least cover the same benefits as Original Medicare Parts A and B. Most plans also offer extra benefits. Your plan provider may require that you get your care from a set network of physicians and facilities in order to get complete coverage. If you aren’t sure about the providers in your plan’s network, ask a representative for this information. 

For Medicare recipients under 65, there are different concerns regarding health care insurance coverage. If you are a woman of child-bearing age or are pregnant, you should review your Medicare benefits to ensure that you have the coverage you need during this time of your life. 

You can get more information about your Medicare benefits from your plan directly or from your health care provider.