Does Aetna cover IUD?

Choosing an intrauterine device (IUD) can be empowering. If you’re wondering, “Does Aetna cover IUD?”—you’re in the right place. This guide explains what Aetna typically covers, including both hormonal and non-hormonal IUDs, eligibility criteria, how to check your coverage, and tips for improving your chances of approval.

Want to check your Aetna IUD coverage? Book a telehealth visit through Klarity Health to review your eligibility and treatment options.

Does Aetna cover IUD?

Under ACA-compliant Aetna plans, FDA-approved IUDs are covered as preventive services with no out-of-pocket costs when received through an in-network provider. Grandfathered or non-ACA plans may still involve cost-sharing. Aetna’s medical policies generally include insertion (CPT 58300) and removal (CPT 58301), covering levonorgestrel-releasing IUDs such as Mirena, Kyleena, Liletta, and copper IUDs like Paragard, depending on plan details.

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What types of IUD does Aetna cover?

Aetna typically covers FDA-approved hormonal (progestin) IUDs and copper IUDs used for birth control or heavy menstrual bleeding. As listed in Aetna’s Clinical Policy Bulletin 0510:

Hormonal IUDs:

• Mirena: Approved for up to 8 years for contraception; up to 5 years for heavy menstrual bleeding.
• Kyleena: Approved for up to 5 years.
• Liletta: Approved for up to 5 years.
• Skyla: Approved for up to 3 years.

Non-hormonal IUD:

• Paragard: FDA-approved for up to 10 years of contraception.

ACA-compliant plans usually cover one device per contraceptive category at no cost. If your preferred IUD isn’t listed, your provider can request a medical exception.

What types of IUD does Aetna not cover?

Aetna may not cover IUDs used for purposes beyond FDA-approved indications. While devices like Mirena and Liletta are approved for treating heavy menstrual bleeding, they are not FDA-approved for managing uterine fibroids (ICD-10 D25.x). If an IUD is used for fibroids, Aetna may classify it as investigational or non-preventive, requiring medical justification and possibly resulting in a denial. Coverage can also be denied for out-of-network care, lack of prior authorization, or devices not on formulary.

Eligibility criteria for Aetna IUD coverage

Coverage depends on several factors:

• Plan type: Most ACA-compliant plans offer full coverage as a preventive benefit.
• Provider network: Use an in-network doctor or clinic.
• Approved indications: Devices must be FDA-approved and prescribed for contraception or conditions like heavy menstrual bleeding or endometriosis.
• Medical necessity: Diagnoses such as N92.0 (excessive menstrual bleeding) or N80.x (endometriosis) may support coverage.

How to check whether my Aetna covers IUD

1. Log in to your Aetna Member Account
   Under “Preventive Services” or “Contraceptive Coverage,” check for covered IUDs like Kyleena, Mirena, Liletta, Skyla, Paragard. These are listed on the preventive drug list.
   
2. Download your plan’s Preventive Drug List PDF
   Look for the IUDs mentioned above to confirm they’re included.
   
3. Call Member Services
   Use the number on your Aetna ID card to verify if your specific plan includes coverage for the device, insertion, and removal, and confirm in-network status.
   
4. Ask your provider or scheduler
   In-network providers often have direct access to verify benefit coverage and can flag if preauthorization is needed.
   
5. Review your Explanation of Benefits (EOB)
   The EOB will list CPT/HCPCS codes like J7296–J7301 (IUD device) and 58300 (insertion), and will indicate payment or denial reasons—particularly useful if coverage was unexpectedly declined

Does Aetna cover IUD online?

Yes—Aetna fully supports telehealth consultations and scheduling IUD insertion with in-network providers. However, remote prescriptions are only step one. Physical insertion must be done in-person at a network clinic. The consultation may start online, but actual insertion, device, and follow-up are covered under your plan if in-network.

Why Aetna might deny IUD coverage

Coverage may be denied if:

• The device isn’t FDA-approved for your condition.
• It’s considered investigational or off-label (e.g., used for fibroids).
• Services were provided out-of-network.
• Required prior authorization was missing.
• Inaccurate or missing diagnostic codes were used.

Tips for improving your chances of Aetna IUD coverage approval

1. Verify device coverage: Confirm your chosen IUD is FDA-approved and listed in Aetna’s Preventive Drug List.
2. Use appropriate ICD-10 codes: Examples include Z30.430 (IUD insertion), N92.0 (heavy menstrual bleeding), and N80.x (endometriosis).
3. Choose in-network providers: Insertion and follow-ups must be conducted in-network.
4. Confirm prior authorization requirements: Check if your plan requires preapproval and ask your provider to submit it.
5. Provide complete medical documentation: Include medical history, past treatments, and supporting test results.
6. Review your EOB: Watch for relevant CPT/HCPCS codes and identify any denial reasons.
7. Understand expulsion risks: Per Paragard’s label, expulsion may occur, especially postpartum.
8. Appeal denials: If denied, work with your provider to submit an appeal with supporting documentation.
9. Explore financial alternatives: If coverage is denied, consider Title X clinics or family planning centers offering IUDs at low or no cost.

How to get prior authorization from Aetna for IUD

1. Consult with your provider: They’ll assess medical needs.
2. Provider submits request: Includes patient history, diagnostic codes, and device type.
3. Aetna reviews: Aetna typically responds to prior authorization requests within up to 30 calendar days (shorter for urgent medical situations).
4. Follow-up if delayed or denied—talk to your doctor or Aetna backup for an appeal.

Key takeaway

Most ACA-compliant Aetna plans cover FDA-approved IUDs, including hormonal and copper options, with no out-of-pocket costs when care is provided in-network. Understanding plan specifics, correct diagnosis codes, and authorization requirements can help you get the coverage you need.

Get your IUD covered through Aetna online

Getting an IUD doesn’t have to be complicated. Book a telehealth visit through Klarity Health to review your eligibility and treatment options. A licensed provider can help you understand which IUDs are covered under your specific plan and walk you through the steps for prior authorization if needed. Klarity makes it easy to connect with in-network providers, so you can avoid delays or unexpected costs. Once you’re approved, your provider will help you plan the in-person insertion and any necessary follow-up care.

Not sure if your insurance covers birth control?

Klarity connects you with licensed providers who can review your benefits and help determine the best birth control options for you.

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