Essure® Insurance Coverage

Good news! Essure may be available at no cost!

Under the Affordable Care Act (ACA), health insurance plans are now required to cover all 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 comply with the ACA, under specific exceptions, some plans are not required to cover birth control options at no cost. Additionally, different plans renew at different times, so please call your health insurance company to verify your benefits before having the procedure.

Here’s how:

  1. Call your insurance company's 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. If your insurance provider asks for specific codes, please provide them with the following:
    • Code 58565 (hysteroscopic sterilization)
    • Code 58340 (modified HSG)
    • Code 74740 (modified HSG interpretation and supervision)
    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.

    If your health insurance provider does not cover the codes listed above, The National Women’s Law Center (NWLC) has a resource that may be of some assistance to you. Visit Coverher.org to learn more about navigating through the health insurance system. You can also call their toll free patient hotline at 1-866-745-5487 to speak to a representative.

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

You may qualify 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 the cost of coverage. Or you may be eligible for the Medicaid or Family Planning programs, which provide comprehensive, low-cost insurance.

Click here to learn about heath insurance coverage options you may be eligible for in your state.