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Medicare benefits might include abortion coverage if criteria is met

Does Medicare Cover Abortion?

Nearly one million women in the U.S. have an abortion each year. Different areas have different abortion rates. While Medicare is often for people who are 65 or older — who will not be bearing children — many individuals under 65 qualify due to disabilities. Medicare benefits might include abortion coverage if certain criteria is met. 

Abortion Methods

An abortion may occur in two primary ways: 1) taking an abortion pill or 2) through an in-clinic procedure. Both methods have their own benefits. Most of the time, you can get an abortion 5-6 weeks following your last menstrual cycle. It’s recommended to schedule your procedure, if that’s what you choose, within the first 12 weeks of your pregnancy to avoid potential problems. 

The Abortion Pill

The pill is also known as a medication abortion. It requires the woman to take two pills up to 48 hours apart. The first has mifepristone (RU-486) and the second has misoprostol. 

Mifepristone causes your body to stop using progesterone, which is one of the primary hormones made during pregnancy. It stops the pregnancy from advancing any further.

The misoprostol causes the uterus to empty, which often leads to cramping and bleeding. It resembles the process of a miscarriage. After the second pill is taken, the bleeding should start within 24 hours, and the whole abortion process should take about 24 hours to complete. 

This method ranges from approximately 91 to 98 percent in effectiveness — depending on how many weeks pregnant the female is when she has the abortion. The medications become less effective if they’re taken further into the pregnancy. A medication abortion can happen within the first 10 weeks of pregnancy, but after that time has passed, an in-clinic abortion must be performed instead. 

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In-Clinic Abortion

In-clinic abortions, also called surgical abortions, are safe prodecures when licensed medical professionals perform them. There are some different kinds of procedures, such as:

  • Suction abortions or vacuum aspiration — this is the most common.
  • Dilation and evacuation — only takes 5-10 minutes to complete; provides an extremely high success rate.

Repeat in-clinic procedures are seldom necessary.

Medicare and Abortion Coverage

Medicare beneficiaries are not given coverage for abortion procedures apart from two cases. This constraint is because of the Hyde Amendment — a legislation piece introduced in 1997 that keep federally-funded medical providers from offering abortion coverage. The amendment covers all abortion cases except for when the woman’s life is in danger or if the pregnancy is caused by rape or incest.  

For coverage questions, contact your plan directly. 

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What About Medicaid?

Medicaid serves millions of low-income women, and approximately two-thirds of female enrollees are in their reproductive years. Again, the federal Hyde Amendment keeps state Medicaid programs from using funds to cover abortions — outside of life endangerment, rape, or incest cases. However, if a state wants to, it can use its own funds to pay for abortions in other circumstances.  

Have More Questions About Medicare Coverage?

If you have more questions about what Medicare covers, keep browsing the TSS blog or call (855) 952-1941. Our specialists are ready to help.