Most people think of Medicare only as health insurance for people over the age of 65, but Medicare covers millions of people who are younger than 65, too. People who have certain disabilities or end-stage renal disease (ESRD) may also be eligible for insurance coverage through Medicare benefits.
In the United States today, approximately one million women from ages 18 to 44 are Medicare beneficiaries, and two-thirds of these women use a form of contraception. Kyleena is a type of hormone-releasing intrauterine device (IUD) that women can use to delay pregnancy for up to five years per device. Kyleena is only available as a brand-name drug with no generic equivalent as of 2019.
If you are wondering if this type of contraception is right for you, and whether your Medicare benefits cover its cost, here is some information that may help you make an informed decision.
How a Kyleena IUD Helps Prevent Pregnancy
Kyleena is an intrauterine device that your health care provider can place non-surgically into your uterus in just a few minutes during an office visit. The Kyleena IUD continuously emits low doses of the hormone progestin, which may prevent pregnancy for up to five years. If at any time during the five-year period you wish to become pregnant, your physician can remove the IUD. There are no lingering hormonal effects after removal of the IUD, and you may be able to get pregnant immediately.
A Kyleena IUD may prevent pregnancy in women by impeding the movement and survival of sperm in the uterus. It also works because the hormone progestin, which the IUD contains, makes the cervical mucus thicken and the lining of the uterus to get thinner.
Kyleena may not be suitable for everyone. After examination and discussion, your health care provider will let you know if you are a good candidate for Kyleena. If you are a woman of childbearing age who receives Medicare benefits and are interested in learning more about your choices for coverage of contraception, you can get information from your health care provider and check with your Medicare plan to find out exact cost and coverage.
Medicare Coverage for Kyleena
How much does Kyleena cost? Without insurance coverage for prescription drugs, your out-of-pocket costs for a Kyleena IUD may be substantial. The price you pay depends on where you live and the pharmacy you use, but the national average cost for a 19.5 mg Kyleena intrauterine device is over $1000.00.
If you are a Medicare recipient who has enrolled in a optional Part D prescription drug plan, or a Medicare Advantage policy that includes prescription drug coverage, you may have coverage for hormone regulating contraceptives like the Kyleena IUD.
Your coverage allowance for Kyleena depends on whether the Medicare Part D or Medicare Advantage plan that you have access to includes Kyleena on its formulary. In the United States every region covered by Medicare has between 40 and 50 different prescription drug plans to choose from. If coverage for Kyleena is important to you, you should look at plans that include it on their formularies before deciding which plan suits your needs best.
Medicare and private insurance plans that offer prescription drug coverage policies have their own formulary, or list of drugs that they pay for. Their lists of drugs are further categorized into tiers which affect your final cost for the drug or medical device. On the first tier are generic drugs with the lowest copayment. Tier two has name-brand, preferred drugs with a medium copayment. And tier three includes non-preferred brand-name drugs with a higher copayment.
The final amount that you pay for a Kyleena IUD depends on if your insurance includes it on its formulary, what tier it is categorized on, and how much your insurance charges for its copayment and coinsurance. If your insurance policy has a deductible, you are responsible for paying that also.