Does Medicare Cover Birth Control? 

Finding the right type of birth control isn’t usually the first thing that comes to mind when thinking about what health care benefits are available for Medicare recipients. However, not all Medicare recipients are over 65 years old. In fact, in the United States today, approximately three percent of all Medicare recipients are between the ages of 18 and 44 and over 920,000 of them are women. 

You may be eligible for enrollment in Medicare insurance if you are younger than 65 or if you have a qualifying disability or medical condition like end-stage renal disease or amyotrophic lateral sclerosis. 

And for Medicare enrollees who are over 65, birth control isn’t used only to protect people from becoming pregnant. Many physicians prescribe oral contraceptives for these common reasons:

• To regulate the menstrual cycle and alleviate symptoms of premenstrual syndrome (PMS)
• To reduce the risk of ovarian and endometrial cancer
• To reduce the risk of pelvic inflammatory disease (PID)

If your physician has prescribed prescription birth control pills or patches, or he has suggested that you use other birth control methods, you might be concerned about whether your Medicare plan covers these expenses. 

Does Medicare cover birth control? 

If you’re only enrolled in Original Medicare Part A (hospital insurance) and/or Part B (medical insurance), you don’t have coverage for birth control. If you want coverage for oral contraceptives (birth control pills), you must enroll in Part D through a stand-alone Medicare Prescription Drug Plan (PDP) or Medicare Advantage plan that includes prescription drug coverage (MA-PD).

Medicare prescription drug plans are sold by private insurance companies. Every Part D plan provider must cover a wide range of prescription medications in the formulary (list of covered drugs), but they have options as to which drugs they cover. Before enrolling in a prescription drug plan, check the formulary to ensure that your prescription contraceptive is on it.  

To get coverage from your Part D plan for prescription birth control, your physician (who accepts Medicare assignment) must prescribe it because it’s medically necessary to treat you. 

The amount you pay out-of-pocket for your prescription birth control depends on what tier your Part D plan has placed it. Medicare drug formularies typically have four tiers, and the higher the tier the higher the cost. Most Part D plans place birth control prescriptions on tier one as a preferred generic prescription with a $0 copayment. 

If you’re enrolled in a Medicare Advantage (Part C)plan that includes prescription drug coverage, your plan should cover your prescription birth control if the plan includes it on the formulary and your physician prescribes it. 

Depending on the type of Medicare Advantage plan you have, you may need to use in-network pharmacies for your prescriptions, otherwise, you might have to pay 100 percent of the cost. If you aren’t sure about plan restrictions or allowances, check your policy for details, or call your plan provider for further information. 

How much does birth control cost without Medicare insurance? 

You may pay the following amounts out-of-pocket for hormonal birth control methods:

• Prescription oral contraceptives: approximately $15 per month
• Contraceptive patches: $30 to $35 for a monthly course of three weeks on and one week off
• A rod implant that’s effective for up to three years: around $1300
• A vaginal ring: $30 to $200 per month

The cost of birth control depends on the brand, the type, and where you get it, so prices can vary across the country.