Medicare does not cover Sprintec or most other birth control pills

Original Medicare (Part A and Part B) does not pay for Sprintec, a combination birth control pill containing norgestimate and ethinyl estradiol. Medicare generally does not cover prescription contraceptives, including pills, patches, rings, or injections. This applies even if your doctor prescribes Sprintec for reasons beyond preventing pregnancy, such as managing heavy periods or endometriosis.

If you have a Medicare Advantage plan (Part C), coverage may differ. Some Advantage plans do cover birth control pills, but the coverage rules and cost-sharing vary by plan. You will need to check your specific plan's formulary — the official list of drugs your plan covers — to know whether Sprintec is included and what you would pay out of pocket.

If you are under 65 and on Medicare because of disability or end-stage renal disease, the same rules explore: Original Medicare does not cover birth control, though a Medicaid plan you may also have might.

Key Takeaways

  • Original Medicare Part A and Part B do not cover any birth control pills, including Sprintec, regardless of why your doctor prescribed it.
  • Medicare Advantage plans sometimes cover birth control pills, but coverage varies by plan and you must check your plan's formulary to know for certain.
  • If you cannot afford Sprintec without coverage, the manufacturer and community health centers offer lower-cost or free options.
  • Medicaid, if you also may have access to, may cover birth control even if Medicare does not.

How to check if your Medicare Advantage plan covers Sprintec

If you are enrolled in a Medicare Advantage plan, the first step is to review your plan's formulary. You can find this document on your plan's website or by calling the customer service number on your insurance card. Ask specifically whether Sprintec is on the formulary and, if it is, what tier it is on — this determines your out-of-pocket cost.

If Sprintec is not covered, ask whether the plan covers other birth control pills. Many Advantage plans cover at least one contraceptive option, even if not Sprintec specifically. Your doctor may be able to switch you to a covered alternative, or you may decide to pay out of pocket if the cost is manageable.

Keep in mind that formularies can change each year during the annual enrollment period (October 15 to December 7). If your plan covered Sprintec last year, confirm it still does before your prescription runs out.

What Sprintec costs without insurance coverage

The retail price of Sprintec varies by pharmacy and quantity, but typically ranges from $20 to $50 per month without any insurance. Prices at different pharmacies can differ significantly, so it is worth calling ahead or using a pharmacy price-comparison tool online.

Several programs can lower this cost. Ortho-Cyclen, the brand name for the same medication as Sprintec, sometimes has manufacturer coupons or patient information programs. You can check the manufacturer's website or ask your pharmacist whether a coupon is currently available. Some community health centers also offer birth control at reduced rates based on income, even if you have Medicare.

Medicaid coverage if you may have access to for both programs

If you are under 65 and on Medicare due to disability or end-stage renal disease, you may also may have access to for Medicaid. Medicaid covers birth control pills in all states, including Sprintec. If you think you might may have access to, contact your state Medicaid office or visit your state's Medicaid website to learn about income and resource limits.

Some people may have access to for both Medicare and Medicaid — a situation called "dual may be able to access." If this applies to you, Medicaid would be your primary payer for birth control, and you would likely pay little to nothing for Sprintec.

Why Medicare does not cover birth control

Medicare's coverage rules were set decades ago and have not changed to include contraceptives. The program focuses primarily on treating illness and injury rather than preventing pregnancy. This is different from many private insurance plans and Medicaid, both of which cover birth control as part of preventive care.

Some people argue that Medicare should cover birth control, especially for older adults managing conditions like endometriosis or heavy bleeding. However, as of now, Original Medicare does not, and there is no indication this will change in the near future.

Other ways to get affordable birth control

If cost is a barrier, several organizations can help. Planned Parenthood and local family planning clinics often offer birth control at reduced rates based on what you can afford to pay. Call ahead to ask about their sliding-scale fees. Some clinics also have programs specifically for people on Medicare.

If you are struggling to pay for Sprintec, talk to your doctor. They may be able to prescribe a generic version, which is usually cheaper, or suggest an alternative birth control method that costs less. Your pharmacist can also tell you whether a generic is available and what it would cost.

What to ask your doctor and insurance plan

Before filling a prescription for Sprintec, ask your doctor whether the medication is covered under your specific Medicare plan. If you have Original Medicare, ask whether there are lower-cost alternatives or whether your doctor thinks the benefit of Sprintec over other options is worth paying out of pocket.

If you have a Medicare Advantage plan, call your plan's customer service line and ask: "Is Sprintec on my formulary, and if so, what is my copay or coinsurance?" If it is not covered, ask what birth control options are covered and whether your doctor can prescribe one of those instead.

Frequently Asked Questions

Can I use a GoodRx coupon or discount card to pay less for Sprintec?

Yes. GoodRx and similar discount programs can sometimes lower the price of Sprintec at the pharmacy, even if your insurance does not cover it. Prices vary by pharmacy and location, so compare prices before filling. These coupons are legal to use alongside Medicare and do not affect your coverage.

If my Medicare Advantage plan covers Sprintec, will I pay the same amount every month?

Usually yes, but it depends on your plan's structure. Most plans have a fixed copay for each prescription. However, if you have not yet met your deductible, you may pay more for your first fill. Check your plan documents or call customer service to confirm.

Does Medicare cover Sprintec if I take it for endometriosis or heavy periods instead of birth control?

No. Medicare does not cover Sprintec regardless of the reason your doctor prescribes it. The medication itself is not covered, whether it is being used for contraception or for another condition. Your doctor may be able to prescribe a different medication for endometriosis or heavy periods that Medicare does cover.

What if I switch from Original Medicare to a Medicare Advantage plan — will my coverage for Sprintec change?

It may. Original Medicare does not cover Sprintec, but some Medicare Advantage plans do. When you switch plans, always check the new plan's formulary before your prescription runs out. You can do this during the annual enrollment period before your coverage starts.

Can I get Sprintec through a mail-order pharmacy to save money?

Yes, if your insurance plan or discount program allows it. Mail-order pharmacies sometimes offer lower prices, especially for 90-day supplies. Ask your insurance plan whether mail-order is an option and whether it would cost less than your local pharmacy.