The Real Cost Of An IUD

Shortly after the election last fall, I called my doctor’s office. When I told the receptionist on the other end of the line that I was hoping to set up an appointment for IUD placement, she laughed. Not dismissive or mocking: just a little sad, a little rueful, the kind of laugh that happens when you’re faced with something too big to fit into words.

“You know, you’re the fifth woman that’s called today to make a placement appointment?” She said after finding my information online. “We’re booked through for the next month.” Her voice softer. “I got mine last week. It felt like a choice; and it was a great feeling. Needed.” And then she cleared her throat and put me on the schedule for December 31st, sent me an email with the confirmation information, and told me she’d update me if anything sooner opened up.

I’d been on extended-cycle pills for four years at that point, and had only given the IUD cursory thought.  I am (immovably so) a creature of habit and inertia, and I’d gotten used to that 8 AM alarm on my phone, that little pink box on my nightstand, the little pillbox tucked into my bag in case I had an early morning. If it isn’t broken, don’t fix it, right? But the night of the election, when all else seemed insurmountable, I found myself searching for something, anything to do at 2 AM. So I read through four years of prescriptions and insurance claims and calculated how much my birth control would cost if I suddenly had to start paying out-of-pocket. $881. Per year.

So, I decided to get an IUD.

I spent the weeks before my appointment researching my options and contacting my parents’ insurance company to make sure my choice would be covered. I decided on the Mirena, a five-year hormonal IUD that multiple friends had raved about, and that was fully covered by my plan. I read testimonial after testimonial about what the appointment was like: some women talked about a consultation first, some about going straight into a placement. I had my annual well-woman visit scheduled for early December, when I got home from college, and the receptionist that I’d spoken to had advised me to just ask my doctor to add an IUD consultation onto the visit (she explained that for their office, a consultation was required, but just involved talking a little bit about my medical background, and then measuring my uterus with a sounding device to make sure the IUD would fit).

Still, I worried about the hidden out-of-pocket costs that seemed to come up so often when things get lost in the havoc of healthcare claims and communications in the U.S. One wrong code from a practitioner, one out-of-network lab, and all of a sudden, you have a $300 bill springing into your life. And yet, I couldn’t find any detailed information about the actual costs of an IUD placement. This, I know, is mostly because healthcare costs can fluctuate so dramatically across states, regions, even towns. There’s no guarantee at all that what I paid (or would have, without insurance) would be what anyone else getting a similar procedure in a similar part of the U.S. would pay. With that said, the following is every test, procedure, and payment that was involved in my IUD placement (in addition to notes about what each test was for/where hidden charges may come in), in the hopes that someone, somewhere might find it helpful in the course of making a decision about their contraception.

Consultation Visit: These are all of the charges from my “consultation,” which in my case was just part of my annual well-woman visit. Most practitioners recommend — or even require — that you’ve had a recent pelvic exam/Pap smear before your IUD placement to avoid potentially spreading infection during the procedure, so these tests will often be done during your consultation in addition to any measurements or medical advisements.

Because of my HMO plan, I’m required to have my primary care physician recommend any specialists that I need, before I can qualify for coverage for those specialized visits; so during my visit, I made sure that my PCP had written a recommendation for the OB/GYN scheduled to place my IUD, and that my insurance company had been contacted. I also confirmed with the nurse on shift that the lab processing my test results was also in-network. Additionally, I know that on my plan, I would have had to pay a copay for the consultation office visit if I’d already had my well-woman visit that year; so that may be a thing to keep in mind if you’ve already maxed out your plan’s office/physician’s visits for the year.

(I do not even know what to do about the number of acronyms in that paragraph. Merp.)

Pap Smear (Lab): $90

HPV DNA Test (Lab): $77

Chlamydia Test (Lab): $77

First Office Visit (IUD consultation, uterus measurement): $137

Placement Visit: These are all of the charges from my second visit for the actual IUD insertion, after I had been approved for placement. A note: Bayer, the company that makes Mirena IUD, works with healthcare providers to supply a certain number of free IUDs to qualifying women (so the only costs would be that of the placement procedure, and a potential office visit charge). My OB/GYN’s office has a fairly straightforward application process for this, though I’m not sure if that extends to other practices. There’s also a recommended string check for 8-12 weeks after your insertion, to make sure the IUD is still in place. I visited my college’s free clinic for mine (with a nurse practitioner; it was easy-breezy!), so I’m not quite sure what costs might be affiliated with a more formal office visit.

Mirena: $868

Placement Procedure: $147

Second Office Visit (the office visit charge for the procedure): $137

Three Month Follow-up/String Check: $0 (at my college’s free clinic)

Total:

$1533 (+ a bottle of Tylenol, two hot pads, and a $2.99 movie rental. They said after-care?)

Eight Months After:

Again, due to my family’s generous insurance policy, as well as the ACA requirements for insurance coverage of any FDA-approved birth control methods, I didn’t pay for any of this out-of-pocket. I know that I have been — and am — incredibly privileged to not only have reliable and generous health insurance through my parents, but also to have ready access to healthcare both at home and in my college town. I am so lucky, and so grateful.

I’ve loved my IUD. I didn’t realize how freeing it’d feel to turn off that alarm (four years!); and I think part of me feels that if my Mirena’s there already, the government can’t decide to also situate itself in my uterus? Of course, that’s not true, and perhaps to articulate it in that way is to dismiss all of the work that still needs to be done to keep affordable care for women at the forefront of healthcare policy. But for me, that privilege — that tiny, plastic, t-shaped bit of privilege — is an everyday reminder not to stop fighting.

Julie Zhou is a writer, editor, and born-and-bred Midwesterner. She loves unreliable magazine quizzes, cast-iron pans, and the Oxford comma. She hates the question, “No, but where are you *really* from?”

Image via Unsplash

  • azreb

    This is great information. I too went through the Mirena process and while I was lucky to have the Mirena and insertion covered, I still ended up having to drop about $500 for office visits and tests over the 3 month period that I got it. If only men knew how much money we had to drop for our sexual health.

  • Yay, thank you so much for this article! I had been thinking about getting an IUD for years, and the election and possibility of losing my ability to have the procedure covered finally made the decision for me, and I got mine the day of the inauguration (I know).

    One thing that isn’t mentioned in the article is the cost saving of no longer having to use menstrual products such as tampons. Although I personally switched to the cup over a year ago, since I got my IUD (mine is very similar to the author’s and is also low hormone), my periods have almost completely stopped, and I just use the occasional liner in case of some spotting. As someone who used to have a pretty heavy period, this has been a HUGE perk of the IUD.

    • Anna Wagner

      Seriously. I no longer get my period with my arm implant birth control and it’s so great. No worrying about having tampons on hand, no paying for tampons and no worrying about whether being on your period is going to interfere with normal activities in any way.

      My implant has been 100% covered by insurance both times I’ve put one in (just got my 2nd one in May), which I’m super grateful for, but even if it wasn’t I still think I’d prefer it to pills.

      • Julia Schnell

        I thought I’d have that perk when I got an arm implant about two years ago and ended up being in the minority that has their period MORE often instead of less. BOO! (I only lasted a year and a half because of that — having a period every other week is kind of exhausting.)

  • Destinee

    In the US, if you have ACA compliant health insurance, most of these things should be completely covered. I didn’t do any follow up visits but my well-woman exam including PAP and chlamydia screening were covered, the cost of the Mirena was covered, and the cost of insertion was covered. I paid $0 out of pocket for my IUD.

    https://www.healthcare.gov/preventive-care-women/

  • sandra

    This would never even be a discussion in Canada. The only thing that people would pay for out of pocket is the cost of the IUD itself, and its around $400 for a Mirena, though most extended health care plans through jobs cover it.

    • Ros

      This. When I got one it was about 80$. Total.

      I am never leaving this province.

    • lateshift

      Yes, we are aware you have great health insurance up there. Congrats. Canadian readers in need of birth control will already know this info, and readers anywhere else can’t do anything at all with the information. But thanks for sharing, I guess.

      (Of course, the point of this post is that under the ACA, most health plans in the US currently cover this completely. Which means that right now, Canadians actually have no real advantage here…so maybe save the usual insufferable insurance bragging for later, if/when they do get rid of the coverage? k thx.)

      • J

        I think the point of the article was to encourage a conversation about IUDs and how much they cost. TFD has many Canadian readers, myself being one of them, and I had no idea that an IUD was affordable until I read these comments. Contraceptive birth control pills are not covered under my province’s health plan, so I would not have assumed that an IUD is. While I’ve never seriously looked into an IUD as an option for myself, I think I will do some research after reading these comments. Talking about this is only benefiting women.

        Thank you ladies for the helpful insight!

  • I got my Mirena in 2013 and the device & implantation was completely covered by my insurance. It was right after the “all birth control must be covered” thing. I got it because my Nuvaring was going to be included in that (since it wasn’t a generic) but Mirena was. I ended up having it removed early because it wasn’t working well for me anymore, but I’m glad that wasn’t a $1600 lesson.

  • Victoria

    It is very important to talk about women’s health, but I am concerned that this article will put people off from getting an IUD. From my experiences and those of my friends, all costs of the Mirena insertion were completely covered by our health insurance. We all have different levels of coverage from different companies, but it was still 100% covered. The only thing I had to pay for was the pregnancy test they do right before, which was $7. $7 is what I paid to not have to worry about periods or babies for 5 years.

    I understand that this article is trying to open up a conversation, but PLEASE include links to different sources and experiences. I’m just afraid that the cost listed here will scare women away from getting an IUD. Please contact your OBGYN and call your insurance to find out the price for YOU, since everyone I talk to with an IUD says “yeah, I got mine for free!”.

    • Julie Zhou

      Hi Victoria! Thank you so much for commenting; and I completely agree that it’s important to highlight that under the ACA, the all well-woman visits and FDA-approved birth control methods are 100% covered, and that IUDs are an incredibly viable, cost-effective birth control method with a myriad of benefits (I apologize if this was poorly paraphrased!).

      I intended for this article to recognize all of those things, while also acknowledging that not all women may not have the privilege of coverage, and that those out-of-pocket costs may become relevant concerns for all women in the coming years of potential healthcare reform; the title was an editorial decision. I apologize if that didn’t come across well, or if there was any element of this piece that read as discouraging or alienating: it was not at all my intention to discourage anyone from getting an IUD (I am absurdly fond of mine), or to alienate anyone’s experience by somehow canonizing my own.

      I’m infinitely grateful for a community in which this kind of dialogue can exist in a safe, thoughtful, and constructive space. As you noted, I did mean for this article to try to open up a conversation, and with that in mind, I absolutely should have thought more deeply about ways to incorporate other perspectives and experiences into this piece, whether through links, quotations, etc., and it’s something that I hope I will reflect more deeply on in future pieces. Thank you again for your comment; and I hope you have a wonderful weekend!

  • Lexie

    My IUD covered by insurance, along with all the visits and my injection for my ectopic pregnancy (caused by the IUD). 🙁

    • Gergana

      I’m sorry, I realize this is probably a sensitive subject and an uncomfortable experience, but.. how did you realize you were pregnant when on IUD? Since I think it stops periods (but wouldn’t know first hand)?

      • Lexie

        Hi! I actually wrote about the whole experience on my blog. http://www.copperoranges.wordpress.com
        Basically I had no idea until I mentioned to my dermatologist that I was spotting and she told me to take a test immediately.

        • Gergana

          Thank you 🙂

  • Towely

    I live in Canada and the total cost to me for my Mirena was 16 bucks. Best 16 bucks I ever spent.

  • Emily Alexander

    Definitely go back for the string check! Mine was recommended for one month, and I’m so glad I went because mine wasn’t where it was supposed to be 😬 I got a new one and am super happy with it now!

  • unbasic_life

    I’ve had a copper IUD (non-hormone) for 8 years and LOVE IT! Is the copper IUD also available in the US?