Does my insurance cover birth control implant?

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birth control implant insurance

Does my insurance cover the birth control implant? If there is a section on birth control implants in your health insurance policy, there is a good chance that you will get the implant for free (or at a discounted price). Because of the Affordable Care Act (aka Obamacare), most insurance plans must cover all methods of birth control, including implants. In this article, in addition to the question “Does my insurance cover the birth control implant“, we tried to clarify many issues that everyone is curious about.

Getting your birth control implant, also called Nexplanon,  can cost anywhere from $0 to $1,300. Removing a birth control implant can cost anywhere from $0 to $300. But the good news is that in most health insurance plans, Medicaid, and some other government programs, birth control implants are available completely free of charge or at a very low cost.

The  upfront cost of a birth control implant,  although more expensive than other methods, allows you to save money in the long run because it lasts for 5 years.

If you don’t have health insurance, you still have options. Depending on your income and legal status in the U.S., you may choose Medicaid or other state programs that can help you pay for birth control and other health care.

Planned Parenthood works to provide you with the services you need, whether you have insurance or not. Most Planned Parenthood health centers accept Medicaid and  health insurance, and many charge less for services and birth control depending on your income.

Does my insurance cover birth control implant?

Does my insurance cover birth control implant?

Birth Control Implant Insurance Fees

The coverage of any medication or service, including birth control, varies depending on the type of insurance plan you have. Birth control is one of the categories that the Affordable Care Act should cover without a contribution or coin, regardless of what type of plan you have and whether you cover your annual deduction. What isn’t specified in the ACA is the  scope of services involved in administering birth control, including the fees your doctor may charge to place or remove an implant. Below are  examples of costs for a Nexplanon birth control implant with different types of insurance plans.

Private Birth Control Implant Insurance

  1. With a dedicated birth control implant insurance plan, you can expect to pay any fees associated with your annual preventive or case-specific gynecological visit.
  2. As for the device itself, Nexplanon’s manufacturer states that 96 percent of people pay nothing for the device.
  3. People who have to pay a portion of the cost (called the out-of-pocket cost) can pay anywhere from $1 to $96 5 for the device.
  4. Before you buy the device, you can check with your health insurance company to find out exactly how much you can expect to pay out of your pocket. This can help save you from surprise costs after the event.

Medicare Birth Control Implant Insurance

  1. As with private insurance, most people with Medicare pay nothing for the device.
  2. According to the manufacturer,  96 percent of people with Medicare don’t  pay out of pocket for the implant. Most doers pay between $3 and $1030.
  3. Because the program is mainly aimed at U.S. adults 65 and older, Medicare generally does not cover birth control.
  4. However, if a doctor determines that certain birth control is medically necessary to address a medical condition, such as ovarian cysts, you may be insured. In this case, Medicare Part B may provide coverage.
  5. If you have a Medicare Part D plan sold by a private insurance company  , you may have birth control insurance to prevent pregnancy.
  6. Depending on your plan or network 〈 especially if you have  a privately available Medicare Advantage plan 〉 you may have certain restrictions on the types of birth control covered and even on medical professionals you may see without additional out-of-pocket expenses.

Medicaid Birth Control Implant Insurance

  1. It offers programs that can help with Medicaid, birth control, and family planning services. It will usually cover birth control of your choice.
  2. Each state has slightly different coverage and out-of-pocket cost. Overall, the birth control implant manufacturer  says that 99 percent of people with Medicaid don’t pay out-of-pocket expenses.  Those who have to pay usually pay between $1 and $945.
  3.  People who receive  both Medicare and Medicaid can have birth control devices, such as implants covered by Medicaid, even if they are  covered by Medicare. People who fall into this group include adults with disabilities and people with certain medical conditions.

Marketplace Insurance

  1. The Marketplace, or “Obamacare” plans, are a result of the passage of the ACA in 2010.
  2. The ACA has expanded insurance coverage for unemployed or low-income Americans.
  3. Through its employers, it has created a market of affordable private insurance plans for people who don’t have insurance.
  4. The ACA also stipulated that certain items, such as birth control, should be under plans sold in the marketplace as well as in commercial markets.
Does my insurance cover birth control implant?

Without insurance, Nexplanon costs about $1,030.64.

If My Insurance Is Not Covered by the Birth Control Implant

Nexplanon is a long-term implant used to prevent pregnancy. Without insurance, Nexplanon costs about $1,030.64. This price will be affected by the cost of a standard OB/GYN office visit as well as placement and removal.

Nexplanon is a type of birth control for women. It attaches to the arm and lasts for up to three years. Manufactured by Organon, which currently makes the only available form of the implant. The list price on their website is 1.030 dollars as of July 2022. This is the price sold to wholesalers or buyers in the United States and probably does not reflect the out-of-pocket cost you will pay, which is ultimately determined by insurance.

The Affordable Care Act (ACA) covers the cost of any form of birth control from any of the FDA-approved birth control methods. If you have insurance, no copays or coins will be paid even if your exemption is not covered. Medicaid covers the cost of Nexplanon, but only 25 states have expanded coverage for family planning services. Therefore, if you do not have insurance or do not qualify for Medicaid, you may face high costs for the Nexplanon implant.

If you don’t have health insurance and  can’t qualify  for Medicaid,  there are options available to help you pay for birth control, including implanted devices. Without insurance, Nexplanon’s list price is 1030 dollars. You’ll also need to pay for an initial appointment with a healthcare professional to discuss birth control options, as well as the placement and eventually removal fee.