KFF Report Highlights Medicare Coverage Rules for Sexual and Reproductive Health Services

Last month KFF released a report and fact sheet explaining Medicare’s coverage rules and restrictions for coverage of sexual and reproductive health services.  

Because of the common understanding of Medicare as insurance for older adults, discourse about the program can often overlook the needs of people with Medicare who can become pregnant. The report notes that, contrary to these assumptions, one million women¹ of reproductive age receive their health insurance from Medicare. Compared to women with Medicare who are over age 65, those eligible for Medicare due to disability are more likely to be Black or Hispanic, have lower incomes, and be in worse health.

Inaccurate stereotypes about older people and people with disabilities can also lead discussions around Medicare to de-emphasize or ignore benefits including screenings for sexually transmitted infections and HIV. The report found these benefits to be largely on-par with coverage in Medicaid and under private insurance.

The report notes that while many contraceptive products are covered under Medicare Part D, coverage and cost sharing for specific methods, particularly intrauterine devices, contraceptive implants and tubal ligation is more variable and limited than what is covered by Medicaid or by federal coverage requirements for private insurance. Abortion care is extremely curtailed – the Hyde Amendment prohibits coverage for abortion care unless the pregnancy is the result of rape or incest, or when the pregnancy poses a threat to the life of the pregnant person. Unlike Medicaid, Medicare also leaves pregnant people with cost-sharing obligations for all pregnancy-related services. This includes cost sharing for prenatal visits and for breastfeeding supports and supplies that are covered without cost sharing in most private insurance.

Read the full report here.

See 10 key facts about Women with Medicare.

1. KFF clarifies that some people who require reproductive health services described here, including contraception and pregnancy and postpartum care, are not women.  The report, and this summary, aim to use language that is as inclusive as possible while also accurately representing survey data that uses gender labels that may not be accurate for non-binary people, trans people and others with gender expansive identities. ↩︎