Medicare Recipient Angry Over Birth Control Access

A 43-year-old woman living in Washington was shocked to find her Medicare coverage did not extend to any birth control.

The woman, who is only comfortable being known as MJ, has multiple sclerosis and has been on Medicare for 10 years.

"Medicare covers zero birth control," MJ told Newsweek. "If it's discussed in an appointment except for purposes of improving general health, the appointment is rejected for payment by Medicare and the patient is charged."

Medicare recipients also often report issues in getting abortions covered as well. While Medicare Advantage plans can fill the gap for birth control coverage, they are still generally forbidden to cover abortion due to the Hyde Amendment from 1997. This amendment barred the use of federal funds to pay for abortion, except to save the life of the woman or if the pregnancy arises from incest or rape.

Because there are around a million women aged 44 and under on Medicare, this presents a serious issue for those in need of reproductive healthcare, MJ said.

"Disabled women on Medicare are being discriminated against in their care in a terrible way," she said. "They do get pregnant and need to terminate."

For some women, their disability and health status won't let their pregnancy proceed, or it could make their disability worse, she added.

Medicare also routinely leaves gaps for those seeking coverage for their eyes, ears and teeth, MJ said.

"The eyes, ears and teeth never made sense to me in the first place," she told Newsweek. "Everyone of any age needs to be able to see, hear, eat and speak. The birth control and abortion gap without any advantage plan available to cover makes Medicare extremely inappropriate as health coverage for disabled people."

Due to the challenges they face in getting appropriate coverage, those with disabilities might suffer at the hands of the system.

"The disabled are a vulnerable population with the same basic rights as everyone but being held to a strange, dangerous, convoluted, secretive, and nonsensical system," MJ said.

Widespread Problem

While Medicare is generally enjoyed by those aged 65 and up, many recipients aren't too happy with their coverage as they navigate a system they don't feel was built for them.

A yearly KFF Survey of Consumer Experiences with Health Insurance found that while most Americans are satisfied with their Medicare experiences, the under 65 group repeatedly reported negative experiences.

Medicare is generally offered to those age 65 and older, but some Americans are able to get access to the program due to specific disabilities or health conditions. Those with a long-term disability also get coverage, along with those who have end-stage renal disease or amyotrophic lateral sclerosis (ALS).

That means 7.7 million Americans under age 65 get Medicare, making up 12 percent of all Medicare recipients.

Roughly 92 percent of those over age 65 gave positive ratings of their Medicare coverage in the KFF survey, but only 79 percent of those under 65 with disabilities did, highlighting the prevalence of X's experience.

The reasons for the dissatisfaction come down to the differing needs of the two groups, Russell Noga, the CEO of Medisupps.com, an online Medicare agency and resource center, said.

"Younger individuals on Medicare often have different health needs compared to the older demographic," Noga told Newsweek. "Those under 65 are typically on Medicare due to disabilities and may require more frequent and specialized care."

Younger Medicare beneficiaries are also often under more intense financial constraints, he said. For those with disabilities, full-time work might not be an option, ultimately leading to heightened cost concerns.

"Medicare beneficiaries are not a monolithic group," Noga said. "Their needs vary widely. Tailoring services and support to accommodate these differences is key to enhancing their Medicare experience."

While Medicare Advantage plans typically offer additional benefits than just Medicare only, many of those under 65 with disabilities have fewer choices on their plan options.

"Depending on where you live, you might find that until you turn 65, your only coverage option is original Medicare by itself or Medicare Advantage," Louise Norris, a health policy analyst for medicareresources.org, told Newsweek. "Medicare Advantage can work well depending on the specifics, but the plans do have prior authorization rules and network restrictions that can be challenging for people with high medical needs to navigate."

Due to these restrictions, the federal healthcare offering sometimes feels neglectful toward the many Americans with disabilities it serves, MJ said.

"The disabled need birth control and abortion coverage as much or more than the general population," she said. "This coverage gap is dangerous, discriminatory and unacceptable."