The arm implant is a highly effective, long-acting reversible contraceptive method that involves the placement of a small, flexible rod beneath the skin of the upper arm. This device continuously releases the hormone progestin to prevent pregnancy for an extended period, typically up to three years. With an effectiveness rate of over 99%, it is one of the most reliable forms of birth control available. The total cost of the implant is highly variable and depends on a person’s insurance coverage, eligibility for assistance programs, and the specific fees charged by the healthcare provider.
The Full Price Without Insurance
The maximum cost a person might face is the manufacturer’s suggested retail price (MSRP) for the device itself, which is the list price before any discounts or insurance are applied. For the most common arm implant, the wholesale acquisition cost is approximately $1,215, with prices ranging from $800 to $1,300. This figure serves as a baseline for the cost of the implant rod itself, but it rarely reflects the final payment made by a patient.
This maximum price does not account for the procedure to insert the device or the eventual procedure to remove it three years later. An individual who is completely uninsured and does not qualify for any financial assistance would be responsible for the device’s full list price and all associated professional fees. Because the arm implant is so effective and lasts for multiple years, the high upfront cost can be more cost-effective over time compared to monthly methods like birth control pills.
Cost Variations Based on Insurance Coverage
For most people with private or commercial health insurance, the arm implant is available at no cost due to the Affordable Care Act (ACA) preventive services mandate. This federal requirement stipulates that most private plans must cover all Food and Drug Administration (FDA)-approved contraceptive methods, including the implant, without imposing cost-sharing like co-pays or deductibles. This means the device itself, and often the insertion procedure, must be covered at a $0 out-of-pocket cost to the patient.
However, certain exceptions can lead to out-of-pocket expenses, even with private insurance. Plans that were in existence before the ACA and have not significantly changed, known as “grandfathered plans,” are exempt from this mandate and may require a co-pay or co-insurance. Furthermore, organizations with religious or moral objections may also be exempt from providing this specific coverage. In these situations, the patient may be responsible for a portion of the cost, which can range from a small co-pay to a few hundred dollars.
A common scenario where costs arise is in high-deductible health plans, where a person may be charged for a visit or procedure if the clinic codes it separately from the preventive service. Even though the device should be covered at no cost, the associated office visit or procedure fees might be applied toward the annual deductible. In these cases, a person could be charged a few hundred dollars before the insurance fully covers the service. It is important to confirm with the insurance provider that both the device and the procedure codes are covered with zero cost-sharing.
Financial Assistance and Low-Cost Options
Individuals who are uninsured, underinsured, or have limited income have several options to access the arm implant at a reduced or zero cost. The federal Medicaid program, a joint federal and state program for low-income individuals, typically covers the arm implant entirely, including the device and the insertion and removal procedures, with no out-of-pocket expense. Coverage under Medicaid is comprehensive for family planning services across all states.
Another significant resource is the Title X Family Planning Program, which funds clinics like Planned Parenthood and local health departments. These clinics are required to offer services on a sliding fee scale based on a person’s income and family size. Individuals with incomes at or below 100% of the Federal Poverty Level often receive the implant and all associated services completely free of charge. Those with incomes between 101% and 250% of the Federal Poverty Level receive a substantial discount, ensuring that the cost is not a barrier to accessing this highly effective method.
The manufacturer of the arm implant also offers patient assistance programs (PAPs) designed to help individuals who are uninsured or underinsured and meet specific low-income criteria. These programs can provide the device at a drastically reduced cost or for free. Eligibility often requires the healthcare provider to apply on the patient’s behalf and verify the patient’s financial status.
Understanding Related Fees
The total expense for the arm implant includes fees for the professional services of the healthcare provider, which are separate from the device’s cost. These services include the initial insertion and the later removal procedure, which is required after three years or when the person wishes to stop using the method. When a person is uninsured, the cost for the insertion procedure can range from approximately $100 to $350, covering the provider’s time, supplies, and the local anesthetic used.
The removal procedure, which typically involves a small incision, can cost between $150 and $500 if paid out-of-pocket. If a person chooses to have a new implant inserted immediately after removal, the two procedures may be combined into a single office visit, which can sometimes reduce the total procedural cost. When insurance covers the arm implant device at no cost, it generally also covers the associated insertion and removal procedures with zero cost-sharing, as they are considered part of the preventive service.