Male contraception: Does insurance cover vasectomies and condoms?

Are vasectomies covered by insurance?

There are no federal rules requiring health plans to cover vasectomies. Although female sterilization (which costs much more than a vasectomy)¹ has to be covered in full by non-grandfathered health plans,² the same is not true for male sterilization.

Some states require state-regulated health plans to cover vasectomies.³ but state laws do not apply to self-insured health plans, which account for the majority of employer-sponsored health plans.⁴ Even when it's not required, however, some health plans voluntarily cover all or part of the cost of a vasectomy, so you should check with your plan to see whether you have vasectomy coverage.

States that require pre-deductible vasectomy coverage must have an exception for HSA-qualified high-deductible health plans (HDHPs) if they want HDHPs to continue to be available, as these plans would cease to be HSA-eligible if they provided pre-deductible vasectomy coverage. (Until the beginning of 2020, the IRS waived that rule,⁵ in response to the fact that some states had implemented vasectomy coverage rules without HDHP exceptions.)

Does Medicaid cover a vasectomy?

Yes, Medicaid covers vasectomies in nearly all states. A 2021 KFF survey received responses from 41 states and DC, all of which reported that their Medicaid programs covered vasectomies.⁶ Healthinsurance.org has reviewed Medicaid benefits in the other nine states, confirming that most of them cover vasectomies.⁷

Federal rules are in place to ensure informed consent and prevent coerced sterilization of Medicaid enrollees. They include a requirement that the person be at least 21 years old, mentally competent, and voluntarily sign a consent form at least 30 days but no more than 180 days before the sterilization procedure is performed.⁸

How much does a vasectomy cost?

On average, a vasectomy will generally cost at least $1,000.⁹ But the cost of a vasectomy depends on where the procedure is performed and whether the patient's health plan provides vasectomy coverage. There is wide variation in billed charges for self-pay vasectomies, depending on the location and facility, ranging from a few hundred dollars to several thousand dollars.¹⁰

Although the billed charges for a vasectomy are generally significantly lower than the billed charges for female sterilization, most health plans are required to cover female sterilization with no out-of-pocket costs. Since insurance coverage for vasectomies varies, couples often find that out-of-pocket costs for a vasectomy are significantly higher than the $0 they will pay for female sterilization under most health plan.¹¹

Are condoms covered by insurance?

Condoms are required to be covered by non-grandfathered health plans as long as they're prescribed by a health care provider to someone who can become pregnant (a woman, trans man, or nonbinary person who could become pregnant). This is due to the Affordable Care Act's preventive coverage rules.

The Women’s Preventive Services Guidelines include all FDA-approved methods of contraception for women, which means that insurers have to cover at least one type of each method at no cost to the member. The women's health guidelines used to specify that condom coverage only included internal condoms, but the coverage requirement was changed to simply "condoms" (including both internal and external) for health plans issued or renewed on or after December 30, 2022.¹² This includes both internal (female) and external (male) condoms,¹³ but the prescription cannot be for a biological male.

The IRS has also issued guidance allowing (but not requiring) HSA-qualified high-deductible health plans (HDHPs) to pay for male condoms pre-deductible, regardless of whether the enrollee is male or female.¹⁴

Over-the-counter condoms, meaning purchased without a prescription, do not have to be covered by health insurance (although they can now be paid for with pre-tax funds from an HSA, FSA, or HRA¹⁵). And condoms prescribed to someone who cannot become pregnant are not required to be covered.

In 2024, the Biden administration proposed removing the prescription requirement for coverage of over-the-counter (OTC) contraception, which would have required health plans to cover OTC condoms. But that rule was withdrawn and never finalized.¹⁶