Medicare coverage of birth control may not be the first thing that comes to mind as being a typical benefit. While most Medicare recipients are 65 years of age or older, Medicare also offers coverage to people under the age of 65 who have certain permanent disabilities or end-stage renal disease.
Today, there are close to 1 million women between the ages of 18 and 44 who receive Medicare benefits. Statistics show that two-thirds of women in this reproductively capable age range use some form of contraception. For these women, information about whether Medicare covers birth control, what types are available, and what the cost advantages are, is essential.
What are Hormonal Contraceptives?
Hormonal contraceptives are a type of birth control that affects a woman’s hormone levels. They come in many different types, the most common of which is known as “the pill.” Your doctor must prescribe hormonal contraceptives and will discuss the best method of birth control for your situation. Your physician will also be able to tell you whether your Medicare plan covers a specific form of contraceptive.
Some of the most common forms of hormonal contraceptives are:
- Birth control pills which are taken orally and affect a woman’s hormone
levels by entering the body through the digestive system.
- Contraceptive skin patches are worn on the skin and hormones are released
into the bloodstream through the skin.
- Contraceptive vaginal rings release hormones when the ring is inserted
directly into the vagina.
- Contraceptive skin implant rods are inserted under the skin of the upper
arm and slowly release hormones into the blood stream for a period of up
to 3 years.
Birth control options are not inexpensive for uninsured women in the age range of 18-44. Average costs for birth control pills in the United States run between $20.00 and $50.00 per pack for a one-month supply. That means a yearly cost of $240.00 to $600.00 out of pocket. Implants that last longer than one year, range between $800.00 to $1000.00 per year.
Does Medicare Cover Birth Control?
If you have Medicare coverage under Medicare Part D prescription drug coverage, your benefits may pay for some types of hormonal contraceptives.
Medicare prescription drug coverage (Part D) helps cover the costs of prescription medications. If you have Original Medicare plan, you can enroll in a stand-alone Prescription Drug Plan. Many Medicare recipients choose to get their Medicare benefits through a Medicare Advantage (Part C) plan. If you join a Medicare Advantage plan, you will have the same coverage as Original Medicare Parts A and B, but many MA plans will include additional benefits including prescription drug coverage.
Which Medicare Part D plan you sign up for depends on the selection of plans that are available where you live. You will have options to choose from, and plan costs and coverage may vary. Each Medicare D plan has its own list of prescription drugs, called a formulary. The type of birth control your plan covers will be listed on its formulary. All formularies have at least 2 options of drugs for every category. They offer a generic brand as well as a brand-name drug option. Tiers of pricing based on brand name and generic options, and if you use an in-network pharmacy or mail order service, can vary.
If you, or a family member have a Medicare Part D, or Medicare Advantage plan and are considering birth control, it is worth your time to find out what your plan covers. Discuss the details with your health care provider and your individual drug plan’s administration.