Medicare does not cover pregnancy care for most people

Original Medicare (Parts A and B) does not cover routine pregnancy care, prenatal visits, ultrasounds, or delivery for people who are 65 and older. Medicare is designed for people age 65 and up, and pregnancy is not a covered service under the program's rules. If you are pregnant and turning 65, or if you are already on Medicare and become pregnant, you will need to look outside Medicare for maternity coverage.

The one exception is if you may have access to for both Medicare and Medicaid at the same time — a situation called "dual may be able to access." In that case, Medicaid (not Medicare) will cover your pregnancy and birth. Medicaid covers pregnancy for people of any age who meet income and other requirements, and it is the main payer for maternity care in the United States.

Key Takeaways

  • Original Medicare does not cover pregnancy, prenatal care, delivery, or postpartum care for anyone, regardless of age.
  • If you are dual may be able to access (on both Medicare and Medicaid), Medicaid will cover your pregnancy and birth.
  • Some Medicare Advantage plans may cover limited maternity services, but you must check your specific plan's coverage before relying on it.
  • If you are pregnant and not yet 65, you may be able to get Medicaid coverage based on pregnancy alone, depending on your state.
  • Pregnancy-related costs not covered by Medicare or Medicaid will be your responsibility, including hospital bills, doctor visits, and delivery fees.

Medicare Advantage plans and pregnancy coverage

Some Medicare Advantage plans (Part C) do offer maternity coverage, but this is optional for the plan and varies widely. Not every Medicare Advantage plan covers pregnancy, and the ones that do may have limits on what they pay for. Before you enroll in a Medicare Advantage plan, you can review the plan's coverage details in the plan's Summary of Benefits and Coverage document, which lists what is and is not covered.

If you already have a Medicare Advantage plan and are pregnant, call the plan's customer service number (on your insurance card) and ask directly: "Does this plan cover pregnancy and maternity care?" Ask what is covered — prenatal visits, ultrasounds, delivery, hospital stays, and postpartum care — and whether you need a referral to an obstetrician or midwife. Get the answer in writing if possible.

Medicaid coverage if you are pregnant

If you are under 65 and pregnant, Medicaid may cover you based on pregnancy alone, even if you would not otherwise meet your state's income limits. Most states have expanded Medicaid to cover pregnant people with higher incomes than they would normally allow. You can find out whether you may have access to by contacting your state Medicaid office or by using the online tool at healthcare.gov, which will direct you to your state's program.

Medicaid covers the full range of maternity care: prenatal visits, lab work, ultrasounds, delivery (vaginal or cesarean), hospital stay, and postpartum care for up to 60 days after birth. If you are already on Medicaid when you become pregnant, your coverage continues. If you are not on Medicaid, you can explore at any time during your pregnancy — you do not have to wait for an open enrollment period.

After you give birth, Medicaid coverage typically continues for 60 days postpartum. After that period ends, you will need to reapply or find other coverage if you remain uninsured. Some states have extended postpartum Medicaid coverage to 12 months, so check with your state program about how long your coverage lasts.

What happens if you are on Medicare and pregnant

If you are 65 or older and pregnant (which is rare but possible), you will need to find coverage outside Medicare. You have a few options: you can enroll in a Medicare Advantage plan that covers maternity (if one is available in your area), you can explore for Medicaid if you meet your state's income limits, or you can pay out of pocket or use private insurance if you have it.

If you are under 65 and not yet on Medicare, do not wait to turn 65 to get maternity care. explore for Medicaid now based on your pregnancy. Medicaid will cover you through pregnancy and 60 days after birth, and you can keep Medicaid after that if you continue to meet income requirements, or you can switch to a different plan when your postpartum coverage ends.

Hospital and delivery costs under Medicare

If you are on Original Medicare and you go to the hospital for delivery, Medicare will not cover the maternity-related portion of your hospital bill. However, if you develop a complication during pregnancy that requires hospitalization — such as gestational diabetes, preeclampsia, or another medical condition unrelated to the pregnancy itself — Medicare may cover that hospitalization as a medical emergency. The distinction is important: Medicare covers the medical condition, not the pregnancy.

This means you could face a large hospital bill for delivery. Hospital bills for vaginal delivery typically range from several thousand to over ten thousand dollars, and cesarean delivery costs more. If you do not have Medicaid or a Medicare Advantage plan that covers maternity, you will be responsible for these costs.

Postpartum care and the newborn

Medicare does not cover postpartum care for the mother or any care for the newborn. If you are on Medicaid, postpartum coverage for you lasts 60 days (or longer in some states), but the newborn is covered separately under the state's Medicaid program for children. The newborn is automatically enrolled in Medicaid at birth if you are on Medicaid, and that coverage continues as long as the child meets your state's income limits.

If you are on a Medicare Advantage plan that covers maternity, check whether it also covers postpartum visits and newborn care. Most do not, so you may need separate coverage for the baby. Many states allow newborns to stay on the parent's Medicaid, but you will need to confirm this with your state program.

How to find out what your plan covers

If you are on Original Medicare, the answer is straightforward: maternity is not covered. If you are on a Medicare Advantage plan, you need to check your plan documents. Look for the Summary of Benefits and Coverage or the Evidence of Coverage document that came with your plan materials. Search for the words "maternity," "pregnancy," "prenatal," or "obstetric." If you cannot find the answer in the documents, call your plan's customer service line.

If you think you might may have access to for Medicaid, go to healthcare.gov or call your state Medicaid office. You can also dial 211 from any phone to reach a local helpline that can tell you about Medicaid and other programs in your area. Have your income information ready, as Medicaid uses income to determine who qualifies.

Frequently Asked Questions

Can I get Medicare if I am pregnant?

No. Medicare is only for people 65 and older (with rare exceptions for people with disabilities or end-stage renal disease). If you are pregnant and under 65, you cannot get Medicare. You should look into Medicaid instead, which covers pregnancy for people of any age who meet income requirements.

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

No. Original Medicare does not cover delivery or any maternity care. If you are on a Medicare Advantage plan, some plans may cover maternity, but you must check your specific plan's documents or call customer service to know for sure.

What if I am on Medicare and have private insurance that covers pregnancy?

Your private insurance would be the primary payer for maternity care, and Medicare would not be involved. Make sure your private insurance plan actually covers pregnancy before you rely on it — some plans exclude maternity unless you paid an extra premium when you enrolled.

Does Medicare cover the baby after birth?

No. Medicare does not cover newborns or children. If you are on Medicaid when the baby is born, the newborn is automatically enrolled in your state's Medicaid program for children. If you are not on Medicaid, you will need to find coverage for the baby through another source.

Can I switch to a Medicare Advantage plan that covers maternity?

You can switch during the Annual Enrollment Period (October 15 to December 7 each year) or if you have a may have access to life event like moving to a new state. Pregnancy itself is a may have access to event in some cases, so contact Medicare at 1-800-MEDICARE to ask whether you can switch outside the normal enrollment window.