Medicare does not cover maternity care for most people, but some beneficiaries may have options

Original Medicare — Part A and Part B — does not pay for pregnancy, labor, delivery, or newborn care. Medicare is designed for people 65 and older, and most pregnant people are younger and covered through employer plans, Medicaid, or the marketplace instead.

If you are pregnant and on Medicare, it usually means you may have access to early because of a disability or end-stage renal disease. In those cases, you will need to look at Medicaid, your state's pregnancy programs, or a Medicare Advantage plan that includes maternity coverage — not all do.

Key Takeaways

  • Original Medicare (Part A and Part B) does not cover any maternity services, including prenatal visits, delivery, or postpartum care.
  • Some Medicare Advantage plans do cover maternity care, but you must check your plan's details before you become pregnant or as soon as you know you are.
  • Medicaid covers the full cost of pregnancy and childbirth for most low-income pregnant people and is often the fastest route if you are uninsured.
  • If you are on Medicare due to disability and pregnant, contact your state Medicaid office to see whether you can enroll in both programs at the same time.

Why Original Medicare does not cover maternity

Medicare Part A covers hospital stays and Part B covers doctor visits and outpatient services. However, both programs explicitly exclude pregnancy and childbirth from their benefit list. This is because Medicare was created to serve people 65 and older, when pregnancy is no longer a typical medical event.

The exclusion applies to all stages: prenatal care, labor and delivery, postpartum visits, and care for the newborn. Even if you have both Part A and Part B, you will pay out of pocket for every maternity service unless you have another form of coverage.

Medicare Advantage plans and maternity coverage

Some Medicare Advantage plans (also called Part C) do cover maternity services, but coverage varies widely by plan and by state. A few plans market themselves specifically to younger people on Medicare due to disability, and those plans are more likely to include pregnancy benefits.

If you are thinking about becoming pregnant or are already pregnant, call your plan directly and ask whether maternity is covered. Do not rely on the plan's website summary — ask a representative to confirm what prenatal visits, delivery, and postpartum care cost under your specific plan. If your current plan does not cover maternity, you may be able to switch to a different Medicare Advantage plan during the annual enrollment period (October 15 to December 7 each year), but only if you act before you become pregnant.

If you are already pregnant when you realize your plan does not cover maternity, you cannot switch plans until the next enrollment period. In that case, Medicaid is usually your fastest option.

Medicaid as the main route for pregnant people on Medicare

Medicaid covers the full cost of pregnancy, labor, delivery, and postpartum care for most low-income pregnant people. In many states, you can be on both Medicare and Medicaid at the same time — this is called being "dual may be able to access."

To find out whether you may have access to for Medicaid in your state, contact your state Medicaid office or call 211 (a free referral line). Medicaid income limits vary by state, but many states allow higher income for pregnant people than for other adults. Some states also have separate pregnancy programs that cover people who earn too much for regular Medicaid.

Medicaid enrollment can happen any time of year if you are pregnant — you do not have to wait for an open enrollment period. Once you are enrolled, Medicaid will cover all prenatal care, the hospital birth, and follow-up visits for you and your baby.

State pregnancy programs outside Medicaid

Some states run their own programs for pregnant people who do not may have access to for Medicaid but cannot afford private insurance. These programs go by different names — some are called "pregnancy programs," others "emergency Medicaid for pregnancy," and some are part of a broader state health plan.

Your state Medicaid office or 211 can tell you what programs exist in your state and whether you meet the income and other requirements. These programs typically cover prenatal care and delivery but may have limits on postpartum coverage.

What to do if you are pregnant and on Medicare

Start by calling your Medicare Advantage plan (if you have one) to ask whether maternity is covered. Get the answer in writing if possible, and ask what your out-of-pocket costs would be for prenatal visits, delivery, and hospital stay.

At the same time, contact your state Medicaid office or call 211 to find out whether you can enroll in Medicaid while on Medicare. Have your income information and proof of pregnancy (a letter from your doctor or a positive test result) ready. In most states, you can enroll in Medicaid when ready if you are pregnant, even if you are already on Medicare.

If you are on Original Medicare (not Medicare Advantage), Medicaid is your main option. Do not delay — the sooner you enroll in Medicaid, the sooner your prenatal care is covered.

Costs for pregnancy care without coverage

If you are on Medicare and cannot get Medicaid or a Medicare Advantage plan with maternity coverage, you will pay for pregnancy care out of pocket. Hospital delivery costs vary widely by location and whether there are complications, but typically range from several thousand to over ten thousand dollars. Prenatal visits, ultrasounds, and lab work add several hundred to a few thousand dollars more.

Some hospitals and clinics offer payment plans or reduced fees based on income. Before your first prenatal visit, ask the clinic or hospital whether they have a financial information program or whether they can work out a payment plan with you.

Frequently Asked Questions

Can I switch to a Medicare Advantage plan with maternity coverage if I am already pregnant?

No. You can only switch Medicare Advantage plans during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event. Pregnancy itself is not a may have access to event for switching plans. If your current plan does not cover maternity, Medicaid is your best option.

Will Medicaid pay for my delivery if I am already on Medicare?

Yes. In most states, you can be on both Medicare and Medicaid at the same time. Medicaid will cover your pregnancy and delivery costs. Once you enroll in Medicaid, tell your hospital and doctor's office that you have both Medicare and Medicaid so they bill correctly.

What if I do not know whether my Medicare Advantage plan covers maternity?

Call your plan's customer service number (on your insurance card) and ask directly. Request written confirmation of what maternity services are covered and what you will pay out of pocket. Do this as soon as possible — if your plan does not cover maternity and you want to switch, you have until December 7 of the current year.

Do I have to pay for my newborn's care under Medicare?

Yes. Medicare does not cover newborn care. Your newborn will need separate health insurance. If you enroll in Medicaid during pregnancy, your newborn is usually automatically enrolled in Medicaid as well. If you have a Medicare Advantage plan with maternity coverage, check whether it covers newborns.

Can I get Medicaid for pregnancy if I earn too much for regular Medicaid?

It depends on your state. Many states allow higher income limits for pregnant people than for other adults, and some have separate pregnancy programs. Call your state Medicaid office or 211 to find out what programs are available and what the income limits are.