Does Medicare Cover Pregnancy and Childbirth?

Medicare is a federal health insurance program. While often associated with individuals aged 65 or older, it also covers younger people with specific disabilities or certain chronic health conditions. Understanding whether Medicare covers pregnancy and childbirth depends on eligibility for the program itself. Pregnancy alone does not grant Medicare eligibility. Coverage hinges on whether the pregnant individual already meets Medicare’s established criteria due to age, disability, or a qualifying illness.

Medicare Eligibility for Birth Coverage

Medicare eligibility is determined by age, disability status, or specific medical conditions, not by pregnancy. Most individuals qualify upon reaching age 65. For those under 65, eligibility is established after receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months. Individuals diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) can receive immediate Medicare coverage without a waiting period.

A pregnant individual must meet one of these criteria for Medicare to cover their pregnancy and childbirth expenses. For example, a person receiving SSDI benefits for 24 months due to a qualifying disability would have their pregnancy-related care covered. Similarly, a person aged 65 or older who becomes pregnant would have their maternity care covered under existing Medicare benefits. Eligibility must be in place prior to receiving these services for coverage to apply.

The 24-month waiting period for disability-based Medicare eligibility begins after an individual becomes entitled to SSDI benefits. This creates a significant delay between disability onset and Medicare coverage. Individuals with ESRD receive Medicare coverage after a waiting period of three months, or immediately if they undergo a kidney transplant. For those with ALS, Medicare coverage begins immediately upon diagnosis and qualifying for Social Security disability benefits, bypassing the standard 24-month waiting period.

Covered Services for Pregnancy and Childbirth

Once eligible for Medicare, the program covers medically necessary pregnancy and childbirth services under its various parts. Medicare Part A, Hospital Insurance, covers inpatient hospital stays. This includes labor and delivery costs, necessary inpatient postpartum care, and services like epidural administration if billed as part of the hospital stay. Part A also covers semi-private rooms, meals, nursing services, and other hospital medical supplies.

Medicare Part B, Medical Insurance, covers outpatient services and physician care. This includes regular prenatal doctor visits, diagnostic tests such as ultrasounds and blood tests, and medically necessary genetic screenings. Physician services during delivery, including obstetrician fees, are also covered under Part B. Follow-up postpartum office visits with healthcare providers fall under Part B coverage.

Medicare Part C, Medicare Advantage Plans, offers an alternative way to receive Medicare benefits. Private insurance companies approved by Medicare provide these plans. By law, Medicare Advantage plans must cover all services Original Medicare (Parts A and B) covers, except hospice care, which remains covered by Original Medicare Part A. While these plans provide the same benefits, they often operate through a specific network of providers and may have different rules for obtaining care, including referrals to specialists. Many Medicare Advantage plans also offer additional benefits beyond Original Medicare, such as vision, dental, or prescription drug coverage.

Understanding Costs and Financial Responsibility

Even with Medicare coverage, beneficiaries are responsible for out-of-pocket costs for pregnancy and childbirth services. For services covered under Medicare Part A, which addresses inpatient hospital care, beneficiaries pay a deductible for each benefit period. In 2025, this inpatient hospital deductible is $1,676. After meeting this deductible, there is no coinsurance for the first 60 days of an inpatient hospital stay. For longer stays, a daily coinsurance applies: $419 per day for days 61 through 90, and $838 per day for lifetime reserve days (up to 60 days over a beneficiary’s lifetime).

For services covered by Medicare Part B, including doctor visits and outpatient care, beneficiaries are responsible for an annual deductible. In 2025, the Medicare Part B annual deductible is $257. Once this deductible is met, beneficiaries pay 20% of the Medicare-approved amount for most covered services, known as coinsurance. Original Medicare (Parts A and B) has no annual out-of-pocket maximum, meaning financial responsibility for coinsurance could be substantial for extensive care.

Medicare Advantage plans, offered by private insurers, have different cost structures. These plans often include monthly premiums, deductibles, copayments, and coinsurance amounts that vary by plan. Medicare Advantage plans have an annual out-of-pocket maximum. In 2025, this limit cannot exceed $9,350 for in-network services, and $14,000 for combined in-network and out-of-network services. Once this maximum is reached, the plan pays 100% of covered services for the remainder of the year. For those with Original Medicare, Medigap (Medicare Supplement Insurance) plans can help cover some out-of-pocket costs, such as deductibles and coinsurance, reducing a beneficiary’s financial burden.

Coordination of Medicare with Other Coverage

When a Medicare-eligible individual has other health insurance, Coordination of Benefits (COB) determines which plan pays first. This ensures claims are paid efficiently and prevents duplicate payments. COB rules depend on the type of other coverage and specific circumstances.

For individuals with Medicare and an Employer Group Health Plan (EGHP), the employer’s size dictates which plan is primary. If the employer has 20 or more employees, the EGHP pays first, and Medicare acts as the secondary payer. This rule applies to working individuals aged 65 or older, and disabled individuals whose employer has 100 or more employees. If the employer has fewer than 20 employees, Medicare pays first.

Medicaid, a joint federal and state program for low-income individuals, also coordinates with Medicare. If an individual is eligible for both programs, Medicaid always acts as the payer of last resort. This means Medicare pays first, and then Medicaid may cover services or costs Medicare does not, such as certain deductibles, copayments, or services not included in Medicare. Other coverage, such as TRICARE for military members and their families or VA benefits for veterans, also has specific coordination rules with Medicare. These rules ensure the primary payer fulfills its obligation before Medicare processes any remaining covered charges.