Medicare's Coverage of Birth Control: The Basic Answer

Medicare Part D (prescription drug coverage) covers most birth control pills, patches, and rings at no cost to you if your plan includes them — but coverage varies by plan, and some methods are not covered at all. The catch is that you must be enrolled in a Part D plan, and your specific medication must be on that plan's formulary (the list of drugs it will pay for). Injectable contraceptives like Depo-Provera are usually covered. Intrauterine devices (IUDs) and implants are typically not covered by Medicare because they are inserted in a doctor's office and fall under Part B (medical services), which has different rules.

If you are under 65 and on Medicare because of disability or end-stage renal disease, the same rules explore. The real question is not whether Medicare covers birth control in theory — it is whether your specific plan covers your specific method, and what you will pay out of pocket.

Key Takeaways

  • Most birth control pills, patches, and rings are covered at no cost under Medicare Part D if your plan includes them on its formulary.
  • IUDs and implants are usually not covered by Medicare because they are surgical insertions, not prescriptions.
  • Coverage and cost depend entirely on which Part D plan you chose — you must check your plan's formulary or call the plan directly to know what you will pay.
  • If your plan does not cover your preferred method, you can switch to a different Part D plan during the annual enrollment period (October 15 to December 7).

Which Birth Control Methods Medicare Part D Covers

Birth control pills are the most straightforward. Most Medicare Part D plans cover at least one brand of oral contraceptive at no cost, though the specific brands vary by plan. Some plans cover multiple options; others cover only one. You pay nothing if you use the covered brand, but if you choose a brand not on the formulary, you may pay the full price out of pocket or a percentage of it, depending on your plan's rules.

Patches (like Ortho Evra) and vaginal rings (like NuvaRing) are also usually covered, though again, which ones and at what cost depends on your plan. Injectables like Depo-Provera are typically covered as well, though you receive them at a doctor's office rather than filling a prescription at a pharmacy.

IUDs (Mirena, Kyleena, Skyla, Paragard) and implants (Nexplanon) are almost never covered by Medicare Part D because they are not prescriptions — they are medical devices inserted by a healthcare provider. They fall under Part B instead, which covers doctor visits and procedures. Part B has a different cost structure: you pay a copay for the office visit, but the device itself may or may not be covered depending on the specific circumstances and your plan.

How to Find Out What Your Plan Covers

The only way to know for certain what your plan covers is to check your plan's formulary or call the plan directly. Do not assume that because one plan covers a method, yours does. Formularies change every year, and plans differ widely.

To check your formulary, log into your Medicare plan's website (you can find the link on your insurance card or on Medicare.gov) and search for your medication by name. Most plans have a searchable formulary tool. If you cannot find it online, call the customer service number on your insurance card and ask whether your specific birth control is covered and what your out-of-pocket cost will be.

Write down the exact brand name and strength of your birth control before you call or search — "the pill" is not specific enough. Your doctor's office can tell you the exact name if you are not sure.

What You Pay Out of Pocket

If your plan covers your birth control, you typically pay nothing. Medicare Part D plans are required to cover all contraceptive methods without cost-sharing under federal law, which means no copay, coinsurance, or deductible for covered methods.

If your plan does not cover your preferred method, you have two choices: pay the full price out of pocket (which can range from $15 to $50 per month for pills, depending on the brand), or ask your doctor whether a covered alternative would work for you. Some people switch to a covered brand; others decide the out-of-pocket cost is worth it for the method they prefer.

If you are paying out of pocket, ask the pharmacy whether a generic version is available — generics are usually much cheaper than brand names and often work the same way.

Switching Plans if Your Birth Control Is Not Covered

If your current Part D plan does not cover your birth control, you can switch to a different plan during the annual enrollment period, which runs from October 15 to December 7 each year. The new coverage takes effect on January 1.

Before you switch, use the Medicare Plan Finder tool on Medicare.gov to compare plans. You can search by medication name and see which plans cover it and what your cost will be under each plan. This tool is free and does not require you to enroll — it is just for comparing.

If you need your birth control before January 1 and your current plan does not cover it, you will have to pay out of pocket for the months between now and when your new plan starts. Some people choose to do this; others ask their doctor for samples or a lower-cost alternative to bridge the gap.

Birth Control for People Under 65 on Medicare

If you are under 65 and on Medicare because of a disability or end-stage renal disease, the same Part D rules explore. Your birth control coverage depends on which Part D plan you are enrolled in, and you can switch plans during the annual enrollment period just as anyone else can.

One difference: if you are also may be able to access for Medicaid (which some people under 65 on Medicare are), Medicaid may cover birth control methods that Medicare does not, including IUDs and implants. Check with your state Medicaid program to see whether you are may be able to access and what it covers.

IUDs and Implants: Why Medicare Usually Does Not Cover Them

IUDs and implants are not covered by Medicare Part D because they are not drugs — they are medical devices that a doctor inserts. This means they fall under Part B (medical services), not Part D (prescriptions).

Under Part B, you typically pay 20 percent of the cost of the device and the insertion procedure after you meet your deductible. The total cost can be $500 to $1,500 depending on the device and your provider. Some Medicare Advantage plans (Part C) may cover IUDs and implants differently, so if you are on an Advantage plan, call your plan directly to ask.

If cost is a barrier, ask your doctor's office whether they offer payment plans or whether there are community health centers in your area that offer IUDs at a lower cost.

Frequently Asked Questions

Does Medicare cover the cost of the doctor visit when I get a prescription for birth control?

Yes. Part B covers the office visit, and you pay your usual copay (usually $15 to $50). The prescription itself is covered by Part D if it is on your plan's formulary. You do not pay separately for the prescription when you pick it up at the pharmacy.

What if my doctor prescribes a brand that is not on my plan's formulary?

You can ask your doctor to request a prior authorization or exception from your plan, which sometimes allows coverage of an off-formulary drug if your doctor explains why you need that specific brand. This takes a few days. Otherwise, you pay the full price out of pocket or ask your doctor for a covered alternative.

Can I get birth control without a prescription under Medicare?

No. Even though some states allow pharmacists to dispense birth control pills without a prescription, Medicare still requires a prescription. You must see a doctor or nurse practitioner to get one, though that visit is covered by Part B.

Does Medicare cover emergency contraception like Plan B?

Some Part D plans cover emergency contraception, but not all. Check your formulary or call your plan to ask. If your plan does not cover it, you can buy it over the counter at a pharmacy for $30 to $50.

What if I am on a Medicare Advantage plan instead of Original Medicare?

Medicare Advantage plans (Part C) include both medical and prescription drug coverage, so birth control coverage rules are the same — it depends on your specific plan's formulary. Call your Advantage plan to check what it covers, or use the Medicare Plan Finder to compare plans during enrollment.