Many women give birth via C-section as part of their birth plan or in cases where other complications make a vaginal birth dangerous or impossible. Although Medicare recipients are often over the age of 65, approximately 15% are under the age of 65 and eligible due to certain disabilities. Many Medicare recipients under 65 may be of child-bearing years and need to know how their Medicare coverage will help cover a C-section if the need arises.

Understanding a C-Section Procedure

A Cesarean delivery, which is more commonly referred to as a C-section, allows a baby to be born via an abdominal incision rather than through the vaginal canal. Most women receive an epidural that allows them to be awake but physically numb during the procedure, although some cases may require full anesthesia if it is determined to be safer for delivery.

There are three types of C-section incisions:

  • Classical incision. When C-sections were first performed, the surgical cut was made vertically across the center of the belly. This may still be used when rapid delivery is necessary or in the case of an extremely preterm birth.
  • Low transverse incision. This is now the most common type of abdominal and uterine incision and is a horizontal cut across the lower abdomen, just above the pubic area.
  • Low vertical incision. This type of C-section incision is reserved for circumstances where the baby is in a position that may be difficult to deliver via the more common transverse incision.

Although C-sections are very common and often safe, they are still major surgeries and there can be risks involved. Your obstetrician can help you understand if you may face an increased chance of health risks during or after a C-section. Certain medical conditions make having a C-section safer than vaginal birth, but those same conditions may require extra precautions in case they lead to complications during surgery.

Even when families expect or plan for a vaginal birth, they should be aware that a doctor may determine a C-section is safer for their circumstances before or during labor. All families should ask their physician to help them become more familiar with the process in case a change in birthing plans must be made. Due to undergoing a surgical procedure, a mother who has had a C-section delivery may need to spend a longer amount of time in the hospital than those who give birth vaginally.

When is a C-Section Necessary?

The Centers for Disease Control and Prevention (CDC) report that almost one-third of all C-sections are performed because the natural approach to labor becomes prolonged or fails to progress and requires surgical intervention. Preexisting conditions or conditions associated with the mother or the baby that have been discovered through the course of pregnancy may mean some women cannot attempt a vaginal delivery and must schedule a C-section. C-sections are also advised when any fetal distress is detected near the birthing window or when babies are not positioned correctly for a safe vaginal birth.

Medicare Coverage for a C-Section

Since a C-section is performed in a hospital and requires a hospital stay during recovery, Medicare Part A benefits provide coverage to pregnant recipients who require this surgery for delivery of their baby. The Part A deductible applies, but recipients who have Medigap may have some of the out-of-pocket costs covered in part or in whole. It’s important to note that most Medigap plans are only available for those age 65 and older, but check plans in your state for eligibility. Medicare Advantage (MA) enrollees will have the same Part A and Part B as Original Medicare, but many MA plans provide additional  benefits.

Low-income recipients of Medicare benefits may quality for Medicaid in their state, which can also offset out-of-pocket expenses. Medicaid may also cover costs associated with an infant’s care after birth, which Medicare benefits do not provide. Eligibility and coverage rules for Medicaid may be different in each state, so Medicare recipients interested in dual eligibility will need to contact their local agency for more information.

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