- Original Medicare — parts A and B — doesn’t cover birth control methods used to prevent pregnancy.
- Medicare Part D prescription drug plans offer some birth control coverage.
- Some Medicare Advantage plans also include coverage for prescription birth control methods.
Although the majority of Medicare beneficiaries are age 65 and older, around 3 percent are between ages 18 and 44 in 2011 — roughly 919,700 women of reproductive age.
If you’re in that group, it can be important to know what parts of Medicare cover birth control and how to get the most coverage.
The Centers for Disease Control and Prevention (CDC) reports that about
In the United States, the most commonly prescribed birth control medications and devices include:
- birth control pills
- contraceptive implants such as Nexplanon
- injectable birth control medications such as Depo-Provera
- intrauterine devices (IUDs)
- birth control patch
- vaginal rings such as NuvaRing
- hysterectomy
- vasectomy
Except in certain medically necessary circumstances, original Medicare — parts A and B — doesn’t cover birth control. Some Medicare Advantage (Part C) and Medicare Part D prescription drug plans do offer some coverage.
Original Medicare
Together, Medicare parts A and B make up “original Medicare.”
Medicare Part A covers inpatient healthcare, like the kind you would receive when admitted to a hospital, for example. Medicare Part B covers healthcare you receive as an outpatient, including doctor’s visits, diagnostic tests, many forms of therapy, and more.
Although Medicare Part B covers many forms of preventive care (including health screenings and vaccines), birth control isn’t included in the preventive coverage offered by Medicare.
Original Medicare also typically doesn’t provide coverage for elective procedures such as vasectomies or implanting birth control devices.
However, there are circumstances when Medicare Part B may cover medications and procedures that are also used for birth control.
Hysterectomies, for example, may be medically necessary to treat certain health conditions. Birth control pills that contain hormones may also be used to
In these cases, Medicare may cover the medications and procedures because they are medically necessary to treat a condition.
Medicare Part D
Medicare Part D prescription drug plans help you pay for the cost of your medications.
Because these plans are offered by private insurance companies, the specific drugs they cover vary from plan to plan. Each plan has a formulary or list of the approved drugs covered by the plan.
Many Part D plans include birth control medications. You can check your plan’s formulary or talk to your insurance provider to be sure the birth control method you’re considering is covered under the plan.
It’s also important to understand your plan’s guidelines in advance. For example, some plans may require you to choose a generic medication if one’s available, or to use a pharmacy that’s part of your plan’s network.
Medicare Advantage
Medicare Advantage (Part C) is private insurance you can buy instead of enrolling in original Medicare. These plans are required to include the same basic coverage as original Medicare, but they often offer extra benefits like vision and dental care.
To find out if your Medicare Advantage plan covers birth control procedures, check with your plan administrator or read over your plan documents. Medicare Advantage plans are private insurance products, so what they cover varies from plan to plan.
Some Medicare Advantage plans include Part D prescription drug coverage as well. As with any Medicare Part D plan, you’ll need to check the plan’s formulary to see which birth control medications are covered.
When you’re discussing birth control methods with your healthcare provider, you may also want to verify your plan’s coverage, so you can keep costs low.
Medicare supplement plans
Medicare supplement plans, also called Medigap, help you cover your portion of Medicare costs, including deductibles, copays and coinsurance.
Medigap plans only cover Medicare-approved medications and procedures, so it won’t help you pay for a birth control method that isn’t covered under Medicare’s rules.
Medicare Advantage and Medicare Part D prescription drug plans are offered by private insurance companies. Their costs vary according to the plan you choose and the coverage it provides.
The chart below contains some examples of common birth control medications and devices, and what your costs may be after you’ve met your annual deductible and paid the plan premium.
| Birth control method | Medicare coverage | Cost per month |
|---|---|---|
| Yasmin birth control pill | 93% of Medicare Part D and Medicare Advantage plans | copay: $0–$2 |
| Ortho tri-cyclen birth control pill | not covered | – |
| Desogen birth control pill | 92% of Medicare Part D and Medicare Advantage plans | copay: $0–$25 |
| Nor-Qd progestin-only birth control pill | 98% of Medicare Part D and Medicare Advantage plans | copay: $0–$1 |
| Xulane contraceptive patch | 65% of Medicare Part D and Medicare Advantage plans | copay: $3–$140 |
| Depo-Provera injection | 97% of Medicare Part D and Medicare Advantage plans | copay: $0–-$96 (one injection) |
| IUDs | not covered | – |
| Nexplanon birth control implants | some Medicare Part D and Medicare Advantage plans | 96% paid $0 in out-of-pocket costs for the implant |
| hysterectomy | Medicare Part B, Medicare Advantage if medically necessary | $904–$1,595 |
To keep your birth control costs as low as possible, make sure to select the right plan for your needs.
Talk with your healthcare provider, insurance company, or benefits administrator to be sure the medications you need are covered under the plans you’re considering.
It’s also important to check your plan’s requirements before you choose a birth control method.
Cost-savings programs
Medicaid is a federally funded healthcare program that’s administered by the state where you live and covers many forms of birth control.
The Centers for Medicare and Medicaid Services (CMS) estimates that around 12.2 million people were dually eligible for Medicare and Medicaid in 2018. To find out if you’re eligible for Medicaid benefits, you can check here.
If Medicare doesn’t cover the birth control method you need, you may want to check with the company that produces your preferred method. Some manufacturers offer discount programs and reduced costs to people who qualify.
There may also be public or private reproductive health programs in your area that offer free or low-cost birth control. Planned parenthood and your local public health clinic can be two good places to start.
To find a public health clinic near you, you can type your location into the
While original Medicare isn’t likely to cover birth control methods unless they’re used to treat another health condition, some Medicare Advantage and Medicare Part D plans do cover them.
If you need birth control to prevent pregnancy, you may need to consider switching to a Medicare Advantage plan that includes coverage of the birth control method you want to use.
To find out whether your plan covers your medications or devices, check with your plan administrator or consult your plan’s prescription drug formulary.
Medicaid, public health departments, and reproductive health organizations like Planned Parenthood may be able to help you get the birth control you need if your Medicare plan doesn’t cover it.