Although the majority of Medicare beneficiaries are age 65 and older, around 3 percent are between ages 18 and 44 in 2011 â€” roughly 919,700 women of reproductive age.
If youâ€™re in that group, it can be important to know what parts of Medicare cover birth control and how to get the most coverage.
Medicare coverage for birth control
The Centers for Disease Control and Prevention (CDC) reports that about 65 percent of women between ages 15 and 49 in the United States used some form of birth control between 2017 and 2019.
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
Except in certain medically necessary circumstances, original Medicare â€” parts A and B â€” doesnâ€™t cover birth control. Some Medicare Advantage (Part C) and Medicare Part D prescription drug plans do offer some coverage.
Together, Medicare parts A and B make up â€œoriginal Medicare.â€
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 doctorâ€™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 isnâ€™t included in the preventive coverage offered by Medicare.
Original Medicare also typically doesnâ€™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 treat health conditions, including:
- ovarian cysts
- polycystic ovary syndrome
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 planâ€™s formulary or talk to your insurance provider to be sure the birth control method youâ€™re considering is covered under the plan.
Itâ€™s also important to understand your planâ€™s guidelines in advance. For example, some plans may require you to choose a generic medication if oneâ€™s available, or to use a pharmacy thatâ€™s part of your planâ€™s network.
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, youâ€™ll need to check the planâ€™s formulary to see which birth control medications are covered.
When youâ€™re discussing birth control methods with your healthcare provider, you may also want to verify your planâ€™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 wonâ€™t help you pay for a birth control method that isnâ€™t covered under Medicareâ€™s rules.
How much will birth control cost if I have Medicare?
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 youâ€™ve met your annual deductible and paid the plan premium.
Getting the most coverage and cost savings
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 youâ€™re considering.
Itâ€™s also important to check your planâ€™s requirements before you choose a birth control method.
Medicaid is a federally funded healthcare program thatâ€™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 youâ€™re eligible for Medicaid benefits, you can check here.
If Medicare doesnâ€™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 CDCâ€™s health department search tool.
While original Medicare isnâ€™t likely to cover birth control methods unless theyâ€™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 planâ€™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 doesnâ€™t cover it.
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