Does Medicare cover tubal ligation?
Tubal ligation (sterilization) is a procedure where a surgeon permanently cuts, closes, or removes pieces of a person’s fallopian tubes. Tubal ligation is a permanent form of birth control that is more than 99% effective in preventing pregnancy.
Experts consider it one of the most effective forms of birth control. However, it may not be right for an individual if they wish to get pregnant in the future.
Medicare may cover tubal ligation under certain circumstances.
While Medicare generally provides healthcare coverage to people 65 years of age or older, people under 65 with certain disabilities or illnesses may also qualify. In 2022, more than 1 million females of reproductive age (20 to 49 years old) received health coverage through Medicare.
Medicare only covers tubal ligation if a healthcare professional deems it medically necessary. It does not cover tubal ligation as an elective procedure.
Either Medicare Part A or Part B will generally cover the procedure, depending on whether a doctor performs it on an inpatient or outpatient basis.
Medicare parts B and D may typically cover contraceptives, like birth control. Part D covers prescription medications, so this part generally covers birth control.
Part B may cover certain types of birth control, like IUDs, for managing specific menstrual illnesses, such as endometrial hyperplasia.
Around 79% of females of reproductive age (20 to 49 years old) with Medicare are also eligible for Medicaid coverage.
If a person has dual eligibility, they may receive a broader coverage of reproductive health services, like tubal ligation, than with Medicare alone.
According to Planned Parenthood, tubal ligation can cost between $0 and $6,000, including follow-up appointments. The overall cost depends on factors like where a person gets the procedure and whether they have health insurance that covers it.
If Medicare covers tubal ligation, an individual may need to pay certain out-of-pocket costs. Medicare Part B has a monthly premium of at least $185 and a deductible of $257. Once a person meets their deductible, they must typically pay 20% of Medicare-covered services and treatments.
Medicare Part A includes a deductible of $1,676 for each in-hospital benefit period. It also involves a daily copayment amount once a person meets their deductible. For up to 60 days, this copayment is $0. For days 61 to 90, the copayment is $419 per day.