Natural Cycles, the FDA-cleared birth control app, is starting to gain insurance coverage, but the reality is inconsistent. Some insurers cover it fully under the Affordable Care Act’s contraceptive mandate, others require you to fight for reimbursement, and many still don’t cover it at all. Whether you end up paying out of pocket depends on your specific plan, your insurer, and how willing you are to navigate the claims process.
What the ACA Requires
The Affordable Care Act mandates that commercial health insurance plans cover all FDA-cleared contraceptive methods without cost-sharing. Natural Cycles received FDA clearance in 2018 as a fertility awareness-based method of birth control, which should, in theory, place it under that mandate. In practice, enforcement has lagged. Natural Cycles itself has noted that despite the ACA’s language requiring coverage of all FDA-cleared contraceptive technologies, pharmacy benefit managers have not added even one fertility awareness-based method to their formularies.
The gap exists partly because Natural Cycles is a digital product, not a pill or device, and the insurance system wasn’t built to process app subscriptions. That’s changing slowly. In April 2024, the Centers for Medicare and Medicaid Services established a dedicated billing code (HCPCS code A9293) specifically for Natural Cycles. This gives healthcare providers and insurers a standardized way to process claims, which removes one of the biggest administrative barriers to coverage.
Which Insurers Currently Cover It
Aetna is the most prominent insurer with an explicit coverage policy. Aetna considers Natural Cycles medically necessary under federal preventive care mandates when prescribed by a treating provider. Coverage includes one annual subscription per benefit period, though no additional supplies or hardware are covered.
Beyond Aetna, coverage is inconsistent and plan-dependent. Many users report needing to call their insurer, file appeals, or submit claims for reimbursement rather than receiving seamless, automatic coverage. If your insurer doesn’t have a clear policy, you may need a prescription from your doctor and persistence with the claims department. The new billing code makes this process more straightforward than it was before 2024, but it doesn’t guarantee approval.
How to Get Reimbursed Through Insurance
The general process works like this: get a prescription for Natural Cycles from your healthcare provider, purchase the subscription yourself, then submit a claim to your insurer for reimbursement. You’ll want to reference the HCPCS code A9293 when filing. If your claim is denied, you can appeal, and citing the ACA contraceptive mandate strengthens your case since Natural Cycles is FDA-cleared contraception.
If your insurer requires a letter of medical necessity, your doctor will need to write one that includes your diagnosis, an explanation of why Natural Cycles is the appropriate contraceptive method for you (for example, if hormonal methods cause side effects), and their recommendation. This is a standard process for any contested insurance claim, and many providers are familiar with it even if they haven’t written one specifically for a contraceptive app before.
Using FSA or HSA Funds
If insurance coverage isn’t an option, your next best path is paying with pre-tax dollars through a Flexible Spending Account or Health Savings Account. Natural Cycles subscriptions are eligible for FSA and HSA reimbursement. You can’t use your FSA or HSA card to purchase directly from the Natural Cycles app or website, but you can buy a subscription, request an itemized receipt at checkout, and submit that receipt to your FSA or HSA administrator for reimbursement.
Natural Cycles has also partnered with FSAstore.com, where you can purchase subscriptions using your FSA or HSA card directly, bypassing the reimbursement paperwork. This is the simplest route if you want to avoid the back-and-forth of submitting receipts.
What About the Thermometer or Oura Ring?
Natural Cycles requires temperature data to work, which means you need either the Natural Cycles thermometer or a compatible wearable like the Oura Ring. Insurance coverage, where it exists, applies only to the app subscription. Aetna’s policy explicitly states that no additional supplies or services are covered beyond the annual subscription. The thermometer and wearable are generally your out-of-pocket expense, though they may qualify for FSA or HSA reimbursement depending on your plan’s rules for medical devices.
What You’ll Pay Without Coverage
If you end up paying entirely out of pocket, Natural Cycles offers both monthly and annual subscription options. The annual plan is the more cost-effective choice and typically runs significantly less per month than many other contraceptive methods, though pricing can vary. Compared to hormonal birth control that’s fully covered by insurance at no cost, any out-of-pocket expense is a meaningful difference. That’s worth weighing against the value of a non-hormonal option if that’s what you’re looking for.
The landscape is shifting in Natural Cycles’ favor. The dedicated billing code, Aetna’s explicit coverage policy, and the company’s own advocacy for ACA enforcement all suggest that broader coverage is coming. For now, your best move is to call your insurer directly, ask whether they cover Natural Cycles under the contraceptive mandate using code A9293, and be prepared to file an appeal or use your FSA/HSA as a backup.