In rare cases, Medicare does cover some services connected to pregnancy and delivery. This is not unexpected given that Medicare beneficiaries include those under the age of 65 who qualify due to a handicap. According to a 2017 CMS study, around 9 million Medicare enrollees (or approximately 16% of all Medicare recipients) qualify for Medicare due to disability. Find out more about this Medicare coverage.
If you or a loved one is a Medicare beneficiary of child-bearing age, you may be asking, "What does Medicare cover throughout pregnancy and child delivery?" According to the CMS Medicare Benefit Policy Manual, Medicare may pay "reasonable and required" skilled medical treatment "during pregnancy, starting with the diagnosis of the disease, continuing through delivery, and terminating just after necessary postnatal care."
If you are pregnant or considering pregnancy, your doctor may be the finest source of information for prenatal care, a safe delivery, and correct postpartum care. If your doctor does not accept Medicare assignments, you may have to pay extra for your healthcare services.
According to the Department of Health and Human Services, your prenatal care may include services such as frequent doctor visits, certain immunizations such as seasonal flu injections, testing for conditions that might affect you or your unborn child, and dietary advice.
Medicare Part B may help pay for certain medical treatments if they are administered in your doctor's office or if they are ordered by your doctor and provided in a clinic or outpatient setting. Once your Medicare Part B deductible has been reached, Medicare will normally cover 80% of the cost of prenatal and postpartum (after birth) medical treatment.
For these services, you will normally pay 20% of the Medicare-approved price. Medicare does not cover your newborn after birth.
Medicare Part A may cover inpatient hospital services, such as childbirth and hospitalization. Once you've reached your Medicare Part A deductible, Medicare will normally pay 80% of the Medicare-approved cost for hospital treatments, with you paying the remaining 20%.
Pregnancy-related care may potentially be covered by Medicare. After you have satisfied your yearly deductible, Medicare coverage may extend to the therapy you get if you suffer a miscarriage, often paying 80% of the Medicare-approved cost.
Medicare coverage is offered for abortions when the pregnancy is the result of incest or rape or presents a substantial risk to your life if you carry your unborn child to term. If you want to end your pregnancy for other reasons, Medicare does not fund elective abortions.
If you need assistance paying for the amount of your medical treatment that Medicare does not cover, there may be options available to you. You and/or your infant may be qualified to enroll in Medicaid. For further information, contact your state Medicaid department.
If you’re pregnant or planning to get pregnant:
If you currently have Medicare coverage
If you may qualify for Medicaid or the Children’s Health Insurance Program (CHIP)
If you don’t have health coverage
It is critical for both the new mom and the infant to have access to healthcare services. Make your application within 60 days of your baby's birth. Your policy can cover you, your kid, and any other members of your home. If your Medicaid or CHIP coverage expired after you gave birth (or if your state has informed you that it will expire soon), you can apply for Medicare coverage.
If you lose your other coverage, you are eligible for a Special Enrollment Period. When completing your application, indicate that you were determined ineligible for Medicaid or CHIP by the state agency.
If you currently have Medicaid coverage
IMPORTANT: Having a baby qualifies you for a Special Enrollment Period
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