Essure® Insurance Coverage

Check with your health insurance to see if you can get Essure at no cost. Under the Affordable Care Act (ACA), many health insurance plans cover FDA-approved methods of birth control for women at no cost.

That means Essure may be available without copays, deductibles, or out-of-pocket-costs.

Although most insurance companies must follow ACA guidelines, there are a few exceptions where plans are not required to cover birth control options at no cost. Also, different plans renew at different times, so please call your health insurance company to confirm your benefits before getting Essure.

Here’s how:

  1. Call the customer service or benefits phone number listed on your health insurance card.
  2. Ask if the Essure procedure is covered without copays, deductibles, or out-of-pocket-costs under the ACA Preventive Services provision. Here are the codes you may need:
    • Code 58565 (hysteroscopic sterilization)
    • Code 58340 (modified HSG)
    • Code 74740 (modified HSG interpretation and supervision)
    • Code 76830 (transvaginal ultrasound)
    If these codes are not covered, ask if they are covered with one of the following diagnosis codes:
    • Z30.2 (encounter for contraceptive management; sterilization)
    • Z30.8 (other specified contraceptive management)
    • Z30.42 (surveillance of an injectable contraceptive)
    • Z98.51 (tubal ligation status)
  3. If you’re currently not covered for the Essure procedure, ask when your health insurance plan will renew, and if at that time, the Essure procedure and Essure Confirmation Test will be covered at no cost.

    Need help understanding your insurance coverage? Visit Coverher.org.

Interested in Essure, but don’t have health insurance?

You may still be able to receive coverage under the ACA. The ACA expands health insurance coverage for millions of patients, making access to health services and treatments like Essure easier and more affordable.

As a result of the ACA, you may now be able to buy health insurance through the marketplaces (also known as insurance exchanges) with financial help to reduce your cost. Or you may qualify for Medicaid or Family Planning programs, which provide comprehensive, low-cost insurance.

Click here to learn about heath insurance options in your state.