No, Original Medicare does not cover birth control. Medicare Part D and Medicare Advantage plans may cover certain birth control methods depending on individual circumstances.
While Medicare primarily covers people ages 65 years and older, younger people with certain conditions or disabilities are also eligible for coverage, and they may wonder if their plans cover birth control.
This article discusses birth control, including possible Medicare coverage through Medicare Part D and Medicare Advantage plans.
Medicare resources
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Original Medicare (parts A and B) does not provide coverage for birth control that is intended to prevent pregnancy.
Medicare Part D is an optional coverage that helps pay for prescription drugs. Some Part D plans provide coverage for birth control in certain medically necessary circumstances, such as to treat endometriosis.
However, this depends on the plan’s formulary, or medication list, and the specific needs of the Medicare recipient.
Some Medicare Advantage plans also include coverage for prescription birth control methods. These plans may offer coverage to younger people with permanent disabilities or conditions.
To be eligible for any healthcare coverage, birth control methods must also be FDA-approved and prescribed by a doctor.
There are many available forms of medically prescribed birth control,
- intrauterine devices (IUDs)
- skin implants
- oral contraceptives
- birth control patches
- hormonal vaginal contraceptive ring
- diaphragms and sponges
- emergency contraception
- sterilization procedures
Medicare generally does not cover “lifestyle items,” meaning it does not provide coverage for medical products and services that people choose to use. Therefore, it also does not cover emergency contraception.
Whether or not a person can receive coverage for birth control depends on their individual circumstances and specific plans.
Original Medicare
Original Medicare parts A and B help cover the costs of many medical expenses, but they do not include prescription drug coverage.
As such, parts A and B do not include coverage for birth control medication. For this, a person will have to purchase a Part D plan.
Although Original Medicare does not provide coverage for birth control for preventing pregnancy, it may cover some birth-controlling procedures as a treatment for certain conditions.
For example, a hysterectomy may be medically necessary to treat a certain health condition, such as cancer, fibroids, or endometriosis.
Medicare Part D
Medicare Part D helps cover the costs of prescription drugs. Some Part D plans include birth control medications that doctors prescribe for certain medical conditions.
For example, birth control pills that contain hormones can
- endometriosis
- ovarian cysts
- polycystic ovarian syndrome (PCOS)
- fibroids
Private insurance companies offer Part D plans, which vary in coverage and cost among providers. It is best to check the plan’s list, or formulary, for any birth control options.
In general, formularies include at least two options for every drug category, including generic and brand-name options.
Medicare Advantage (Part C) plans
Medicare Advantage plans are an alternative to Original Medicare and may offer additional benefits, such as vision, hearing, or dental care.
However, all Medicare Advantage plans must provide at least the same level of coverage as Original Medicare. Advantage plans may also require a person to use in-network healthcare providers and facilities.
If a person is enrolled in Original Medicare, they can choose to switch or enroll in an Advantage plan offered in their area. Costs may include the plan premium, deductibles, and copays.
The most common Advantage plans include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNPs)
Medicaid
According to the Medicare website, around 70% of women of reproductive age who receive Medicare due to a disability also qualify for Medicaid.
People who are eligible for both may receive help paying for birth control. Although the federal government regulates Medicaid services, the rules and restrictions may differ depending on the state.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The amount a person pays for Medicare plans, including Part D and Medicare Advantage, depends on several factors.
These factors include any annual Medicare cost changes and individual Part D or Advantage plan premiums.
Original Medicare costs
A person does not receive birth control coverage under Medicare parts A and B. However, the 2024 costs for these are as follows:
- Part A premium: $0 for most people
- Part A deductible: $1,632 for each inpatient hospital benefit period, and extra costs for inpatient stays
- Part B premium: $174.70 monthly, or higher depending on income
- Part B deductible: $240 yearly
- Part B coinsurance: usually 20% of the cost for each Medicare-covered service or item after paying the deductible
Part D and C costs
Costs for Part D include the monthly premium, deductibles, coinsurance, and copays. However, the costs vary by plan. These amounts can change each year.
Like Part D, Medicare Advantage (or Part C) costs vary depending on the specific plan.
A person can use this online tool to find a 2024 Medicare plan.
Some Medicare plans offer birth control coverage to younger people who meet certain criteria. These plans include Medicare Part D and Medicare Advantage plans.