Does Medicare Cover Abortion?
- Medicare coverage can be confusing, and it's not always clear where the medical necessity line is drawn. Find out if Medicare covers abortion and when.
Medicare does cover abortion as a medically necessary procedure in very specific circumstances. The U.S. government has rules about when federal programs or programs that are federally funded can be used to cover abortion.
Does the U.S. Government Pay for Abortions?
Yes, some federally funded programs do help cover the cost of abortions. However, the circumstances under which those programs can pay for or help fund abortions are limited by a law called the Hyde Amendment, which was a response to the Supreme Court's 1973 Roe v. Wade decision that abortion was not illegal.
The Hyde Amendment limits how federal funds can be used to cover abortion. The Hyde Amendment isn't a permanent law. It's a rider each year on the Congressional appropriations bill used to fund the Department of Health and Human Services. As of early 2021, the amendment had been renewed every year for more than 40 years.
When Does Medicare Cover Abortions?
Medicare covers abortions as allowed under the Hyde Amendment. That means abortion may be covered by Medicare if a pregnancy was the result of either incest or rape. An abortion might also be covered as a live-saving measure for a mother. To count as a covered, life-saving measure, the following facts must be in place prior to the abortion:
- The mother must have some type of physical illness, injury or condition, either prior to pregnancy or caused by the pregnancy.
- The condition or result of the condition coupled with the pregnancy puts the mother's life in danger.
- A physical certifies that the above two facts are true, and the mother is in danger of death if an abortion is not performed.
The above coverage limitations are true for both Original Medicare coverage as well as Medicare Advantage Plans. Since state Medicaid programs are partially federally funded, it's true for those as well.