Tubal ligation, also called sterilization, is a procedure where a surgeon permanently cuts, closes, or removes pieces of your fallopian tubes. Tubal ligation is a permanent form of birth control that’s 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 you if you wish to get pregnant in the future.
Medicare may cover tubal ligation under certain circumstances.
While Medicare generally provides healthcare coverage if you’re 65 years or older, if you’re under 65 years old with certain disabilities or illnesses, you 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 doesn’t cover tubal ligation as an elective procedure. Medicare Part A or Part B covers 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.
Medicaid
Around 79% of females of reproductive age (20 to 49 years old) with Medicare are also eligible for Medicaid coverage.
If you have dual eligibility, you 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 you get the procedure and whether you have health insurance that covers it.
If Medicare covers tubal ligation, you 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 you meet your deductible, you 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 you meet your deductible. For up to 60 days, this copayment is $0. For days 61 to 90, the copayment is $419 per day.