Medicare's coverage of birth control depends on which part of Medicare you have and what type of contraception you need

Original Medicare (Parts A and B) does not cover most birth control methods. However, if you are enrolled in a Medicare Advantage plan (Part C), your coverage may include contraception — the specifics vary by plan. Additionally, if you may have access to for Medicaid alongside Medicare, Medicaid covers the full range of FDA-approved contraceptive methods at no cost to you.

The rules around contraception coverage changed significantly in 2023 when the Affordable Care Act's preventive care requirements were extended to Medicare beneficiaries. This means some birth control options may now be covered under certain circumstances, but the details depend on your specific plan and situation.

Key Takeaways

  • Original Medicare (Parts A and B) does not cover birth control pills, patches, rings, or most other contraceptive methods.
  • Medicare Advantage plans vary widely in what they cover — you need to check your individual plan's formulary or call the plan directly to know what is included.
  • If you have both Medicare and Medicaid (dual may be able to access), Medicaid covers all FDA-approved birth control methods with no copay or deductible.
  • Some contraceptive devices like IUDs may be covered under Medicare Part B as durable medical equipment in limited cases, but this is rare.
  • Planned Parenthood and community health centers offer sliding-scale fees for contraception if you are uninsured or underinsured.

What Original Medicare does and does not cover

Original Medicare (the combination of Part A hospital coverage and Part B medical coverage) does not pay for birth control pills, patches, vaginal rings, or injections. These are considered preventive medications, and Original Medicare does not include a prescription drug benefit — that is what Part D is for. If you take birth control pills, you would need to enroll in a separate Part D plan to have any coverage at all, and even then, coverage depends on whether your specific medication is on that plan's formulary.

Intrauterine devices (IUDs) and implants are sometimes covered under Part B as durable medical equipment if they are inserted in a hospital outpatient setting and meet specific medical criteria. This is uncommon and usually only happens if the device is being used to treat a medical condition rather than for contraception alone. You would need to check with your provider and Medicare directly to know whether your situation qualifies.

Sterilization procedures like tubal ligation or vasectomy are not covered by Original Medicare unless they are performed in a hospital inpatient setting and meet other specific conditions. Most sterilizations happen in outpatient surgery centers, which Original Medicare does not cover.

How Medicare Advantage plans handle birth control

Medicare Advantage plans (Part C) are required to cover at least the same services as Original Medicare, but they can add extra benefits. Many plans do include prescription drug coverage as part of their plan, which means birth control pills and other hormonal methods may be covered if they are on the plan's formulary. However, the copay amounts, deductibles, and which specific medications are covered vary significantly from plan to plan.

To find out whether your Medicare Advantage plan covers your birth control, call the plan's customer service number (on the back of your insurance card) and ask them to check the formulary for your specific medication. You can also ask whether there are any prior authorization requirements — some plans require your doctor to get approval before they will pay. If your current medication is not covered, ask whether the plan covers similar alternatives that might work for you.

If you are shopping for a new Medicare Advantage plan during open enrollment, you can compare plans on Medicare.gov and filter by whether they include prescription drug coverage. Plans that include drug coverage are sometimes called "MAPD" plans (Medicare Advantage Prescription Drug plans).

If you have both Medicare and Medicaid

If you are dual may be able to access — meaning you have both Medicare and Medicaid — Medicaid covers all FDA-approved contraceptive methods with no copay, no deductible, and no prior authorization required. This includes birth control pills, patches, rings, shots, IUDs, implants, diaphragms, and emergency contraception. Medicaid's coverage is more comprehensive than Medicare's, so your Medicaid coverage takes priority for contraception.

To use your Medicaid coverage, you present your Medicaid card to the pharmacy or provider. You do not need to involve Medicare in the transaction. If you are unsure whether you have Medicaid, contact your state's Medicaid office or call 211 to find out.

Part D prescription drug plans and birth control

If you have Original Medicare and want coverage for birth control pills or other hormonal methods, you must enroll in a Part D prescription drug plan. Part D plans are offered by private insurance companies approved by Medicare, and each plan has its own formulary — the list of medications it covers.

Some Part D plans cover birth control pills with a low or zero copay, while others may charge a copay or require prior authorization. You can compare Part D plans on Medicare.gov during the annual open enrollment period (October 15 to December 7 each year) and filter by whether they cover your specific medication. If you miss the open enrollment important date, you may still be able to enroll if you have a may have access to life event like losing other health coverage.

If your current Part D plan does not cover your birth control or charges a high copay, you can switch to a different Part D plan during the next open enrollment period. You can also ask your doctor whether there is a similar medication on your plan's formulary that might work for you.

Community health centers and sliding-scale options

If you do not have coverage for birth control or the copay is too high, community health centers and Planned Parenthood locations offer contraception on a sliding-scale fee basis. This means the cost is based on your income — the lower your income, the lower the fee. You do not need insurance to use these services.

To find a community health center near you, visit the Health Resources and Services Administration (HRSA) website at findahealthcenter.hrsa.gov or call 211. To find a Planned Parenthood location, visit plannedparenthood.org or call 1-800-230-7526. Many of these centers also offer counseling to help you choose the contraceptive method that is right for you.

What to do if your birth control is not covered

If Medicare or your Part D plan does not cover your current birth control, you have several options. First, ask your doctor whether there is a similar medication on your plan's formulary that might work for you — sometimes switching to a generic version or a different brand in the same drug class can solve the problem.

Second, ask your doctor to submit a prior authorization request to your insurance plan. Some plans will cover a medication that is not on the formulary if your doctor documents that you have tried other options and they did not work for you. This process usually takes a few days to a week.

Third, you can appeal your plan's decision if they deny coverage. Your plan must provide you with a written explanation of why they denied coverage and instructions for how to appeal. You have the right to request an independent review of your appeal.

Finally, if none of these options work, community health centers and Planned Parenthood can provide contraception at reduced cost based on your income.

Frequently Asked Questions

Does Medicare cover emergency contraception like Plan B?

Original Medicare does not cover emergency contraception. If you have a Part D prescription drug plan, it may cover Plan B or other emergency contraceptive pills, depending on the plan's formulary. If you have Medicaid, it covers emergency contraception with no copay. Community health centers and pharmacies sell Plan B over the counter without a prescription for around $40 to $50.

Will my Medicare Advantage plan cover an IUD?

Some Medicare Advantage plans cover IUDs, but it depends on the specific plan. Call your plan's customer service number and ask whether they cover IUD insertion and the device itself. If they do, ask whether there is a copay, deductible, or prior authorization requirement. If your plan does not cover it, a community health center may offer IUD insertion on a sliding-scale fee.

Can I get birth control without telling Medicare?

Yes. You can pay out of pocket for birth control at a pharmacy or community health center without involving your insurance. Community health centers offer sliding-scale fees based on income, which is often cheaper than paying the full pharmacy price. You can also ask your pharmacy for the cash price of your medication — it is sometimes lower than the copay.

What if I switch Medicare Advantage plans — will my birth control still be covered?

It depends on the new plan's formulary. Different plans cover different medications. Before you switch plans, check the new plan's formulary on Medicare.gov to see whether your birth control is covered. If it is not, ask whether a similar medication is covered or whether you can request prior authorization. You can only switch plans during the annual open enrollment period unless you have a may have access to life event.

Does Medicare cover the cost of a sterilization procedure?

Original Medicare covers sterilization only if it is performed in a hospital inpatient setting, which is rare. Most sterilization procedures happen in outpatient surgery centers, which Original Medicare does not cover. Medicare Advantage plans may cover outpatient sterilization — check your plan's coverage or call customer service. Medicaid covers sterilization procedures in most states with no copay.