Does Medicare Cover Nexplanon? 

Pharmaceutical birth control has come a long way since 1960 when the first hormone-control contraceptive was introduced. Since then, many types of birth control medications have become available, and intrauterine devices (IUDs) have also become popular. More recently, medicines like Nexplanon (etonogestrel) have become the preferred choice for women who would rather not have to take a daily pill to prevent contraception.

What is Nexplanon?

Nexplanon is a birth control medication administered slowly over time via a rod implant. This implant is placed in a woman’s arm, releasing medicine over time. This medicine works to prevent pregnancy by blocking the release of eggs from the uterus while also preventing sperm from fertilizing eggs in a woman’s body.

The implant used to release the birth control medication can provide support for up to three years. It is made of a thin, flexible plastic material that should not interfere with daily life. In addition, because the medication is released automatically in measured doses, a woman who has receives the Nexplanon implant does not need to take medication manually. This can provide assurance for women who don’t like the idea of having to remember to take a birth control pill on a scheduled basis or who want to have added confidence when engaged in sexual activity using prophylactics like condoms.

Does Medicare cover Nexplanon?

Medicare benefits are available to seniors in the United States, and the age to qualify for Medicare coverage is 65, unless you qualify earlier due to certain disabilities. Although the majority of female Medicare recipients do not need to be concerned about the potential for pregnancy having gone through menopause, younger Medicare recipients may wonder whether Medicare benefits cover Nexplanon or other birth control solutions.

Medicare coverage for birth control

Medicare benefits pay for healthcare services and items that are considered medically necessary. The Centers for Medicare & Medicaid Services (CMS) views birth control as a lifestyle concern in most cases. However, there are instances where birth control may be medically necessary to help women who experience other medical issues. Medicare Part D may cover oral birth control medications if your doctor believes them to be medically necessary.

Coverage for Nexplanon may be more challenging to obtain. If Medicare coverage is available for Nexplanon under your plan, it may be covered by Medicare Part B since the medication needs to be administered in a clinical outpatient setting. Since Nexplanon needs to be implanted by a healthcare professional in a medical office, the implantation procedure is considered an outpatient service.

Medicare Part B covers 80% of all outpatient services under Original Medicare. This is the same part of Medicare insurance that covers doctor visits. In addition, if you require diagnostic testing or lab work in conjunction with your concerns about birth control and pregnancy, Medicare Part B may supply benefits for these services.