Sponsors (4)
The bill expands and clarifies contraceptive coverage for Medicare populations—reducing out‑of‑pocket costs and improving access for many—but increases federal costs, imposes administrative burdens, and relies in part on studies whose recommendations may delay some benefits.
Medicare beneficiaries (including women and Medicare Advantage enrollees) will receive no Part B cost‑sharing for contraceptive items and services starting Jan 1, 2027, and Part D contraceptives will be exempt from deductibles/cost‑sharing, reducing out‑of‑pocket costs and improving access.
Dual‑eligible and low‑income beneficiaries (Medicare + Medicaid) will be better protected against coverage gaps so Medicare contraceptive coverage is at least as comprehensive as state Medicaid, improving consistency and access for low‑income populations.
Congress and agencies will receive evidence‑based recommendations (GAO/HHS studies) within about a year to identify gaps and propose legislative or administrative fixes to expand contraceptive coverage.
Taxpayers and Medicare beneficiaries face increased federal spending (SMI Trust Fund and potential wider Medicare costs) if contraceptive coverage expands, which could put pressure on premiums, budgets, or require offsets.
Hospitals, providers, Medicare Advantage organizations, and Part D sponsors will face administrative and compliance burdens to implement new coverage rules, guidance, and quality measures, increasing provider costs and operational complexity.
Beneficiaries may wait up to a year (or longer) for studies and recommendations before some policy changes take effect, delaying access improvements for people currently lacking coverage.
Based on analysis of 5 sections of legislative text.
Requires Medicare Part B to cover contraceptive items and related clinical services with no cost‑sharing starting Jan 1, 2027, and mandates studies of contraceptive coverage gaps across payers.
Official title: Amend title XVIII of the Social Security Act to provide coverage of contraceptive items and services at no cost-sharing under the Medicare program, and for other purposes.
Introduced December 18, 2025 by Margaret Wood Hassan · Last progress December 18, 2025
Requires Medicare Part B to cover a broad set of contraceptive items and related services without cost‑sharing beginning January 1, 2027, and removes Part B cost-sharing and deductible barriers for those services. Directs HHS to study access to prescription and over‑the‑counter contraceptives for beneficiaries with disabilities who enroll only in Original Medicare, and directs GAO to study gaps in contraceptive coverage across public and private insurance (including Medicaid, Medicare, and TRICARE) and differences for dual Medicare‑Medicaid enrollees, reporting recommendations to Congress within specified timeframes.