Original Medicare does not cover birth control, although Medicare Part D and Medicare Advantage plans offer coverage depending on certain conditions.
While Medicare primarily covers people aged 65 years and older, younger people with certain conditions or disabilities are also eligible for coverage. In 2011, more than in the 18–44 age group received Medicare insurance coverage, notes the Kaiser Family Foundation (KFF).
This article discusses birth control, including possible Medicare coverage through Medicare Part D and Medicare Advantage plans. It also looks at costs.
Birth control, which is also called contraception, is the term for any medicine, device, or method used to prevent a person from getting pregnant.
According to a study published in the New England Journal of Medicine, 45% of all pregnancies in the United States in 2011 were unintended. However, access to birth control has multiple barriers, notes the American College of Obstetricians and Gynecologists.
There are many available forms of medically prescribed birth control, including:
- intrauterine device (IUD)
- skin implants
- hormone injection
- oral contraceptives
- birth control patch
- hormonal vaginal contraceptive ring
- diaphragms and sponges
- emergency contraception
- sterilization procedures
While birth control may prevent pregnancy, it does not prevent the transmission of sexually transmitted infections (STIs). To prevent STIs, a person could also use a barrier method of birth control, such as a diaphragm or condom.
The program includes:
- Part A provides hospital insurance
- Part B offers medical insurance
Part C, also known as Medicare Advantage, which offers an alternative to original Medicare (Part A and Part B)
- Part D prescription drug coverage
To be eligible for any healthcare coverage, birth control methods must be FDA-approved and prescribed by a doctor.
Original Medicare (parts A and B) does not provide coverage for birth control. However, Medicare Part D and Medicare Advantage plans may offer coverage to younger people who have a permanent disability or conditions such as end stage renal disease.
Medicare Part D helps cover the costs of prescription drugs. A person enrolled in original Medicare may choose to add Part D coverage.
Private insurance companies offer Part D plans, which vary in coverage and cost among the different providers.
In addition, the list of approved drugs may also be different, and a person may need to check their plan’s list, which is also called a formulary, for any birth control options. A person may ask for an exception if their plan does not cover a specific drug.
In general, formularies include at least two options for every drug category, including a generic and brand name option.
Medicare Advantage 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)
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.
Part D costs
A person can use this online tool to find a 2021 Medicare plan.
Some Advantage plans offer zero premiums, while others may charge a premium. A person will also pay the monthly Part B premium.
In addition, some Advantage plans may charge copays and deductibles, such as $10 or $20 copay for each doctor visit. However, out-of-pocket costs are generally lower than with original Medicare, and there is usually an annual limit after which a person will not pay for covered services.
This online tool can help a person find a plan and compare costs.
Some Medicare plans offer birth control coverage to younger people who meet certain criteria. These plans include Medicare Part D and Medicare Advantage plans.