Does Medicare Cover Birth Control?

Although most of us are age 65 and over when we get our Medicare benefits, there are over 9 million people under the age of 65 with Medicare. For many of these 9 million people, birth control is still a valid concern. If you need coverage for birth control pills, Medicare Part D and Medicare Advantage plans with drug coverage will provide them.

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• Birth control methods are used to prevent pregnancy from occurring through protective actions, medication, or medical devices.
• Surgical birth control can be a permanent method of preventing pregnancy.
• Medicare Part A and Part B do not cover birth control unless it is part of another covered treatment or service.
• Medicare Part D prescription drug plans provide coverage for birth control pills if they are on the plan’s approved drug list.
• Medicare Advantage plans with built-in drug coverage can help with the costs of birth control pills.
• Medigap policies cannot help with birth control costs unless Medicare Part A and/or Part B covers it as part of a Medicare-approved service.

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What Is Birth Control?

Birth control, also known as contraceptives, refers to activities, medications, and equipment that prevents pregnancy. If non-medical birth control methods such as abstinence or condoms are not desired options for birth control, there are other options. Medical birth control methods should be discussed with your healthcare provider to determine which method is the safest and most effective, including:[mfn referencenumber=1]hopkinsmedicine.org, “Contraception/Birth Control“, Accessed November 3, 2021[/mfn]

• Oral Pills
• Implants
• Injections
• Patches
• Sponges
• Diaphragms or cervical caps
• Hormonal vaginal contraceptive ring
• Intrauterine device (IUD)

Morning-After Pills

Morning-after pills are emergency contraceptives for when a person’s primary birth control method fails. They can help prevent pregnancy if taken soon after unprotected sex. Most morning-after pills are available without a prescription, but they are not intended to be used as a primary birth control method.[mfn referencenumber=2]mayoclinic.org, “Morning-after pill”, Accessed November 3, 2021[/mfn]

Surgical Sterilization

If the birth control methods listed above are not effective or safe long-term, you can discuss surgical sterilization options with your doctor. These options include:[mfn referencenumber=1]hopkinsmedicine.org, “Contraception/Birth Control“, Accessed November 3, 2021[/mfn]

• Hysterectomy
• Tubal ligation or tubal occlusion
• Tubal sterilization Essure system
• Vasectomy

Sexually Transmitted Infections

While these birth control methods are able to prevent pregnancy, they are not effective in the prevention of sexually transmitted infections (STIs). The only birth control methods that can protect against STIs are barrier methods such as condoms and abstaining from sexual activity.[mfn referencenumber=3]hopkinsmedicine.org, “Sexually transmitted diseases” Accessed November 3, 2021[/mfn]

How Does Medicare Cover Birth Control?

In most cases, Medicare Part A and Part B do not cover birth control. Medicare does cover birth control when it is part of medically necessary treatment. One such example is a hysterectomy when a patient is at high risk of uterine cancer or for the treatment of heavy menstrual bleeding with a hormonal IUD.[mfn referencenumber=4]Medicare.gov, “Surgery“, Accessed November 3, 2021[/mfn]

Medicare Part D

Although Original Medicare does not cover birth control most Medicare Part D prescription drug plans and Medicare Advantage plans with Part D coverage do. Private insurance companies offer Part D plans, which vary in cost and coverage. The list of approved drugs is different with each plan. You will need to check the plan’s drug list, called a formulary, for birth control options. Typically, formularies include two or more options for every drug category, including a generic and brand name option.[mfn referencenumber=5]Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 3, 2021[/mfn]

How Much Does Birth Control Cost?

The cost for birth control services can vary widely depending on the type of birth control and the area the service is provided. If the provided birth control treatment was an outpatient service, Medicare would pay 80 percent of all approved costs once the beneficiary has paid their annual Part B deductible. If any providers or facilities involved with the treatment charge Part B Excess Charges, the beneficiary is responsible for paying these costs.

If the birth control treatment requires the beneficiary to be admitted into inpatient care, these costs are covered by Medicare Part A, which has a benefit period deductible. However, Part B covers physician services for non-hospital employees, such as the surgeon or the anesthesiologist. Inpatient surgery services include daily room and board, laboratory services, diagnostic tests, surgical equipment and supplies, anesthesia, and nursing services, and other health professionals.

Birth Control Pills

For birth control pills, the cost can reach up to $50 for a month supply without coverage.  If the birth control pills are covered by your Part D prescription drug plan, you may only have to pay a small copayment depending on your Part D formulary.[mfn referencenumber=6]plannedparenthood.org, “How do I get birth control pills?“, Accessed November 12, 2021[/mfn]

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Summary

If you are hoping that your Original Medicare benefits will cover a particular birth control method for you, that is unlikely to happen. Only birth control pills have coverage and even those are only covered by Medicare Part D and Medicare Advantage plans with drug coverage. If you want to prevent accidental pregnancy, but abstinence or condoms will not suffice, consider those options for birth control pill coverage. You may also consider checking a public health program in your state for birth control methods at a reduced cost.