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 DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... and Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). with drug coverage will provide them.
- 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 AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. 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.
- MedigapMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. policies cannot help with birth control costs unless Medicare Part A and/or Part B covers it as part of a Medicare-approved service.
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:1hopkinsmedicine.org, “Contraception/Birth Control“, Accessed November 3, 2021
- Oral Pills
- Diaphragms or cervical caps
- Hormonal vaginal contraceptive ring
- Intrauterine device (IUD)
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.2mayoclinic.org, “Morning-after pill”, Accessed November 3, 2021
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:1hopkinsmedicine.org, “Contraception/Birth Control“, Accessed November 3, 2021
- Tubal ligation or tubal occlusion
- Tubal sterilization Essure system
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.3hopkinsmedicine.org, “Sexually transmitted diseases” Accessed November 3, 2021
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 necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. 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.4Medicare.gov, “Surgery“, Accessed November 3, 2021
Medicare Part D
Although Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. 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 formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered., for birth control options. Typically, formularies include two or more options for every drug category, including a generic and brand name option.5Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 3, 2021
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 beneficiaryA person who has health care insurance through the Medicare or Medicaid programs. has paid their annual Part B deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.. If any providers or facilities involved with the treatment charge Part B Excess ChargesA Medicare Part B excess charge is the difference between a health care provider’s actual charge and Medicare’s approved amount for payment., the beneficiary is responsible for paying these costs.
If the birth control treatment requires the beneficiary to be admitted into inpatient careInpatient care refers to care provided in a hospital or other inpatient facility. Inpatients are admitted and stay at least one night depending on their condition., these costs are covered by Medicare Part A, which has a benefit periodA benefit period is a method used in Original Medicare to measure a beneficiaries use of hospital and skilled nursing facility (SNF) services. With each new benefit period, the beneficiary is charged a new benefit... 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 copaymentA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. depending on your Part D formulary.6plannedparenthood.org, “How do I get birth control pills?“, Accessed November 12, 2021
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.
- 1hopkinsmedicine.org, “Contraception/Birth Control“, Accessed November 3, 2021
- 2mayoclinic.org, “Morning-after pill”, Accessed November 3, 2021
- 3hopkinsmedicine.org, “Sexually transmitted diseases” Accessed November 3, 2021
- 4Medicare.gov, “Surgery“, Accessed November 3, 2021
- 5Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 3, 2021
- 6plannedparenthood.org, “How do I get birth control pills?“, Accessed November 12, 2021