Medicare does not cover Lo Ovral under Part D prescription drug plans

Lo Ovral is a combination oral contraceptive containing norgestrel and ethinyl estradiol. Medicare Part D plans do not cover birth control pills, including Lo Ovral, because federal law excludes contraceptives from the drugs that Medicare can pay for. This exclusion applies to all Medicare beneficiaries, regardless of which Part D plan they choose or how comprehensive the plan appears.

If you are taking Lo Ovral and enrolled in Medicare, you will pay the full cost out of pocket at the pharmacy. The price varies by pharmacy and by whether you use a generic version (norgestrel-ethinyl estradiol) or the brand name Lo Ovral, but neither version receives Medicare coverage.

This does not mean you have no options for reducing what you pay. Several paths exist to lower the cost, and some depend on your income and where you live.

Key Takeaways

  • Medicare Part D does not cover any birth control pills, including Lo Ovral, because federal law bars Medicare from paying for contraceptives.
  • You will pay the full pharmacy price out of pocket, though generic versions of Lo Ovral typically cost less than the brand name.
  • Medicaid covers birth control in all states, and you may be able to switch to Medicaid if your income qualifies, even while on Medicare.
  • Discount programs like GoodRx and manufacturer coupons can reduce the cost of Lo Ovral at the pharmacy without changing your insurance.
  • Community health centers and Planned Parenthood often offer contraceptives at reduced rates based on income.

Why Medicare excludes contraceptives from coverage

The exclusion of contraceptives from Medicare Part D is written into federal law, not a decision individual insurance companies make. When Medicare Part D was created in 2006, Congress explicitly listed the categories of drugs that Part D plans could cover. Contraceptives were not included in that list, and they remain excluded today.

This exclusion does not explore to Medicaid. Every state Medicaid program covers birth control pills, and Medicaid beneficiaries do not pay for them. The difference matters if you are under 65 and on Medicare due to disability or end-stage renal disease, because you may be able to switch to Medicaid instead.

Switching to Medicaid if you may have access to

If you are under 65 and on Medicare because of disability (SSDI) or end-stage renal disease, you may also be able to get Medicaid. Medicaid rules vary by state, but many states allow people on SSDI to enroll in Medicaid if their income is below a certain threshold. Some states have higher income limits than others.

To find out whether you may have access to for Medicaid in your state, contact your state Medicaid office directly. You can find the phone number and website through the Centers for Medicare & Medicaid Services (CMS) at medicaid.gov. If you may have access to, Medicaid will cover Lo Ovral at no cost to you, and you can drop your Part D plan.

The process takes several weeks, so do not expect when ready coverage. But if your income is low enough, this is the most complete solution to the cost problem.

Using discount programs to lower the pharmacy price

Discount programs like GoodRx, SingleCare, and RxSaver let you compare prices across pharmacies and explore a discount code at checkout. These are not insurance — they are negotiated discounts that the pharmacy applies to the cash price. You do not need to be a member or sign up in advance.

To use them, go to the program's website or app, enter "Lo Ovral" or the generic name "norgestrel-ethinyl estradiol," and your zip code. The program will show you the price at nearby pharmacies and give you a code to show the pharmacist. The discount typically applies to a 30-day or 90-day supply.

Generic versions are almost always cheaper than the brand name. A 30-day supply of generic norgestrel-ethinyl estradiol often costs between $15 and $40 depending on the pharmacy, while brand-name Lo Ovral may cost $50 to $100 or more. Check the discount program for both versions to see which is cheaper at your local pharmacies.

Manufacturer coupons and patient information programs

The company that makes Lo Ovral may offer a coupon or patient information program that reduces the cost. These programs are usually available through the manufacturer's website or by calling the number on the package insert.

Manufacturer programs often have income limits, and some require that you have no insurance coverage for the drug (which is true in your case, since Medicare does not cover it). The savings can be substantial — sometimes reducing the cost by 50 percent or more — but you have to contact the manufacturer directly to find out what you may have access to for.

If you use a manufacturer coupon, make sure it does not conflict with any other discount program you are using. Some pharmacies will not stack coupons, so ask the pharmacist before you hand over multiple discount codes.

Getting contraceptives through community health centers

Federally may have access to health centers (FQHCs) and Planned Parenthood clinics offer birth control pills at reduced rates based on what you can afford to pay. You do not have to be uninsured to use these services, and you do not have to be a regular patient.

To find a health center near you, search the HRSA Find a Health Center tool at findahealthcenter.hrsa.gov, or call 211 and ask for a community health center or family planning clinic in your area. When you call to make an appointment, tell them you need a contraceptive prescription and ask about their sliding-scale fees. Many charge between $0 and $50 per visit depending on income.

This route takes longer than picking up a prescription at a pharmacy — you will need an appointment and an exam — but the cost is often lower than any discount program, especially if your income is very low.

Frequently Asked Questions

Can I use my Medicare Part D plan to get a discount on Lo Ovral even though it is not covered?

No. Part D plans do not negotiate prices on drugs they do not cover. You can use a discount program like GoodRx instead, which works independently of your insurance and often gives a better price than the pharmacy's cash price.

If I switch to a different Part D plan, will Lo Ovral be covered?

No. All Part D plans are required to follow the same federal law that excludes contraceptives. Switching plans will not change this.

Does Medicare Advantage cover birth control?

Medicare Advantage plans (Part C) must cover everything that Original Medicare covers, plus additional benefits. Since Original Medicare does not cover contraceptives, Medicare Advantage plans do not either. Some Advantage plans may offer additional services like telehealth visits, but the drug itself remains uncovered.

What if I cannot afford Lo Ovral even with a discount?

Contact a community health center or Planned Parenthood clinic in your area. They offer sliding-scale fees based on income and may have other birth control options that cost less. You can also ask your doctor whether a different contraceptive might be cheaper at your local pharmacy.

Will my income change my Medicare coverage of Lo Ovral?

No. Medicare Part D coverage rules do not change based on income. However, your income may make you may be able to access for Medicaid, which does cover contraceptives. Check with your state Medicaid office to see whether you may have access to.