Medicare Abortion Coverage in 2025: Costs and Options for Original, Advantage & Drug Plans

Medicare coverage for abortion services in 2025 is highly restricted under federal law, allowing coverage only in cases of rape, incest, or when the pregnancy endangers the life of the pregnant individual. This limitation stems from the Hyde Amendment, which bars federal funds from being used for most abortion procedures.

Medicare may cover medication abortions using misoprostol or procedural abortions, but only under these strict conditions. Some states, such as California, Illinois, New York, Oregon, and Washington, supplement federal restrictions by using state funds to provide broader abortion coverage through Medicaid.

It's important to note that abortion coverage laws are evolving rapidly, with changes varying by state, so availability and coverage options can shift unexpectedly.

Medicare Part A: Hospital Insurance Coverage and Costs

Part A covers inpatient hospital care, which may include procedural abortions requiring hospitalization. Whether an overnight stay is necessary depends on your healthcare provider's assessment.

Most beneficiaries do not pay a monthly premium for Part A. For those who do, premiums are $285 or $518 monthly in 2025.

Key 2025 inpatient hospital costs include:

• $1,676 deductible per benefit period
• No coinsurance for days 1-60 after deductible
• $419 coinsurance daily for days 61-90
• $838 coinsurance daily for days 91-150 using lifetime reserve days
• Full cost responsibility after day 150

Medicare Part B: Outpatient Medical Coverage and Costs

Part B covers outpatient medical services, including most procedural abortions, doctor visits, pelvic exams, and lab tests related to abortion care.

In 2025, the standard Part B monthly premium is $185, though it may be higher based on income.

After a $257 deductible, beneficiaries typically pay 20% coinsurance for Medicare-approved services.

Medicare Part C (Medicare Advantage): Comprehensive Coverage and Costs

Medicare Advantage plans (Part C) must offer at least the same coverage as Original Medicare, including eligible inpatient and outpatient abortion care.

Many Part C plans include prescription drug coverage (Part D), potentially covering medication abortions with misoprostol.

Additional benefits like transportation to medical appointments may also be offered.

Costs such as premiums, deductibles, and copayments vary by plan. Staying within the plan's network generally reduces expenses.

Medicare Part D: Prescription Drug Coverage and Costs

Part D does not cover mifepristone, commonly used as the first drug in a two-drug medication abortion regimen.

However, it does cover misoprostol, which can be used alone to induce abortion.

Part D may also cover medications aiding recovery after abortion, including pain relievers and anti-nausea drugs.

Coverage and costs depend on each plan's formulary and tier system, with generic misoprostol typically being a lower-cost option.

Summary

Federal law restricts Medicare abortion coverage to cases involving rape, incest, or life-threatening risks. Coverage details and costs vary across Original Medicare, Medicare Advantage, and Part D plans.

For questions about abortion coverage eligibility under Medicare, call 800-633-4227 (TTY: 877-486-2048).

To understand your legal rights, contact the Repro Legal Helpline via their secure online form or at 844-868-2812.

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