Most health insurance plans are required to cover the birth control implant at no cost to you. Under the Affordable Care Act, private insurance plans must cover all FDA-approved contraceptive methods, including implanted devices, without charging a copay, coinsurance, or requiring you to meet your deductible first. That said, a few important exceptions exist that could leave you with a bill ranging anywhere from $0 to $2,300.
What the ACA Requires
The federal contraceptive coverage mandate applies to all private health insurance plans in the individual, small group, and large group markets. This includes plans purchased through the Health Insurance Marketplace and employer-sponsored coverage. As long as you see an in-network provider, the implant and the office visit for insertion should be fully covered with zero out-of-pocket cost. The mandate covers both the device itself and the procedure to place it. Removal is also typically covered, though it’s worth confirming separately with your insurer.
Plans That Don’t Have to Cover It
There are three main situations where your plan may not cover the implant:
- Grandfathered plans. If your employer’s health plan hasn’t made significant changes since the ACA took effect in 2010, it may be exempt from the contraceptive mandate. These plans are increasingly rare, but they still exist. Your plan documents or your HR department can tell you if your plan is grandfathered.
- Religious or moral exemptions. Houses of worship and nonprofit religious organizations are fully exempt from covering contraception. After the Supreme Court’s 2014 Hobby Lobby decision, closely held for-profit companies with religious objections can also opt out. In these cases, employees may still be able to get coverage through a workaround where the insurer or plan administrator provides contraceptive benefits separately, but this isn’t guaranteed.
- Out-of-network providers. Even if your plan covers the implant, going to a provider outside your network can result in charges. Always confirm your provider is in-network before scheduling the procedure.
Medicaid and the Birth Control Implant
Medicaid covers contraception in every state, but how smoothly that works in practice varies. One longstanding issue involved the implant’s high upfront cost. Hospitals and clinics had to absorb the price of the device and weren’t always reimbursed separately for it, which discouraged some facilities from offering it. Starting with South Carolina in 2012, states began changing their Medicaid payment policies to reimburse the device and insertion as a separate line item. As of early 2023, 41 states plus Washington, D.C. have adopted this approach, making it significantly easier for Medicaid patients to access the implant.
If you’re on Medicaid, the implant should be available to you at no cost. Some states have also eliminated sliding-scale copays for contraceptive devices entirely.
State Laws That Add Protection
Several states go further than federal law. States like California, Oregon, Connecticut, Massachusetts, Maryland, Nevada, Hawaii, Rhode Island, and Washington, D.C. have significantly expanded contraceptive access over the past 15 years. These laws often require state-regulated insurers to cover all FDA-approved contraceptive methods and prohibit cost-sharing for those methods. If you live in one of these states and your plan is regulated at the state level, you may have stronger protections than the federal baseline provides. States like Kansas and Mississippi, by contrast, offer minimal additional coverage beyond federal requirements.
How Much It Costs Without Insurance
Without any coverage, the implant can cost up to $2,300 for the device and insertion combined. Removal can add another $300. These numbers make the implant one of the more expensive contraceptive methods upfront, though it’s worth noting the device now lasts up to five years. The FDA recently approved extending the implant’s duration from three years to five based on clinical trial data showing it remains effective for the full period. Spread over five years, even the full retail price works out to less than $50 per month.
Planned Parenthood and community health centers often offer the implant on a sliding fee scale if you’re uninsured or underinsured.
How to Verify Your Coverage
The implant (brand name Nexplanon) can be classified under your medical benefit or your pharmacy benefit, and the distinction matters when you call your insurer. Here’s how to confirm your coverage before scheduling an appointment:
- Call the number on your insurance card. Ask specifically about coverage for Nexplanon, and clarify that it’s a physician-administered birth control drug, not a device. This distinction affects how the claim is processed.
- Ask whether it’s covered under your medical or pharmacy benefit. If the medical benefit doesn’t cover it, ask to be transferred to someone who handles pharmacy benefits, as it may be covered there instead.
- Confirm that both the device and procedure are 100% covered. If not, ask what your out-of-pocket costs would be for insertion and, separately, for removal.
- Write down the name of every representative you speak with. If a billing dispute comes up later, having this record helps.
Your provider’s office may also be able to run a benefits check for you. Many clinics that regularly place implants have staff experienced in navigating insurance verification for this specific procedure.