Fidelis Care members have access to the following family planning services: prescription birth control medicines, birth control devices (IUDs and diaphragms), emergency contraception, sterilization, pregnancy tests, prenatal care, and abortion services.
Does NY Medicaid cover birth control?
Birth control pills, injectables, patches, condoms, diaphragms, implantables, and intrauterine devices (IUDs) are all covered by the New York State Medicaid program. The most effective contraceptives are long-acting reversible contraceptives (LARCs), such as IUDs and contraceptive implants. LARCs have the advantage of requiring no ongoing effort on the part of the user for long-term and effective use. Since April 1, 2015, more than 22,000 fee-for-service (FFS) Medicaid clients have chosen LARC as their birth control option.
Fee-for-Service LARC Reimbursement Facts
Because the New York State Medicaid pharmacy formulary does not include LARCs, and the devices are not covered as Medical/Surgical Supplies, IUDs and contraceptive implants are not available to Medicaid FFS members through a pharmacy.
The invoiced LARC cost may be billed as an ordered ambulatory service by hospital outpatient department clinics and free standing diagnostic treatment center clinics with the designated category of service of 0163 (ordered ambulatory diagnostic and treatment center) or 0282 (hospital based ordered ambulatory). The cost of LARC is deducted from reimbursements to Ambulatory Patient Group (APG) facilities and reimbursements to Federally Qualified Health Centers under the Prospective Payment System.
Medicaid Managed Care (MMC) plans were encouraged to accommodate and promote LARC coverage for women during their postpartum inpatient hospital stay beginning May 1, 2014. MMC plans must create methods to pay hospitals for immediate postpartum LARC apart from reimbursement for the inpatient stay as of September 1, 2016, according to the Department of Health.
What is covered under Fidelis?
Well-visits, vaccines, and preventive screenings are all examples of preventive care. Dental and vision care are provided. Prescription and over-the-counter medications. Ambulance and emergency room services are available.
Does Fidelis Medicaid need referrals?
These services do not require a recommendation from your primary care physician. Call Fidelis Care’s Member Services Department at 1-888-FIDELIS if you have any questions or need more information about these non-covered services (1-888-343-3547).
Is birth control covered by Medicaid?
No, only birth control for women is covered. Male birth control, such as condoms and vasectomies, is not covered by health insurance. In some areas, Medicaid covers the cost of family planning services and supplies for eligible men and women. To see if you qualify for coverage for family planning services, contact your local state Medicaid office. Furthermore, some jurisdictions mandate that plans cover vasectomies.
Is birth control free in NYS?
Birth control is available in health centers, family planning clinics, and through your doctor.
Birth control is mandated to be covered without a cost by health insurance policies. If you’re thinking about getting an IUD or implant, check with your insurance company about the costs of insertion and removal. You may potentially be qualified for the Medicaid Family Planning Benefit Program, a public health insurance program that covers family planning services for New York residents. To find a location to enroll, call 800-541-2831.
- Condoms, birth control, and other sexual health treatments are provided for free by some sexual health care providers (PDF).
- Teens can use the NYC Health Map to locate clinics that provide birth control.
How much does the birth control pill cost?
The cost of birth control tablets varies from $0 to $50 each month. With most health insurance policies, or if you qualify for some government programs, they can be completely free.
A doctor or nurse at a doctor’s office, health clinic, or your local Planned Parenthood health center can write you a prescription for the birth control pill. You can even receive a prescription online or via a pharmacist in a select states.
Your nurse or doctor will go over your medical history with you, take your blood pressure, and perform any other necessary medical exams. If you require an examination, the cost ranges from $35 to $250. (but it may be free if you have health insurance).
Planned Parenthood strives to make health care more inexpensive and accessible. Some health centers have the ability to charge based on income. The majority of people accept health insurance. Medicaid or other programs may be able to help you save money if you qualify.
To find out more about the prices in your area, contact your local Planned Parenthood health center.