Objectives: The aim of this study was to investigate the relationship between primary insurance type and major complications after hysterectomy. Methods: A retrospective analysis was performed on women with Medicaid, Medicare, and private insurance who underwent hysterectomy from January 1, 2012, to July 1, 2014, and were included in the Michigan Surgical Quality Collaborative. Major complications within 30 days of surgery included the following: deep/organ space surgical site infection, deep venous and pulmonary thromboembolism, myocardial infarction or stroke, pneumonia or sepsis, blood transfusion, readmission, and death. Multivariable logistic regression was used to identify factors associated with major complications and characteristics associated with the Medicaid and Medicare groups. Results: A total of 1577 women had Medicaid, 2103 had Medicare, and 11,611 had private insurance. The Medicaid and Medicare groups had a similar rate of major complications, nearly double that of the private insurance group (6.85% vs 7.85% vs 3.79%; P =500 beds). Conclusions: Women with Medicaid and Medicare insurance have increased odds of major complications after hysterectomy. Abdominal hysterectomy, BMI, and smoking are potentially modifiable risk factors for women with Medicaid. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.