Is Nexplanon (etonogestrel implant) covered by Oscar insurance?

Nexplanon Coverage by Oscar Insurance

Nexplanon (etonogestrel implant) is likely covered by Oscar Insurance with no cost sharing due to the Affordable Care Act mandate that requires private health insurance plans to cover all FDA-approved contraceptive methods without out-of-pocket costs.

Coverage Details and Background

The Affordable Care Act (ACA) contraceptive coverage mandate, issued in August 2012, requires most private health insurance plans, including Oscar Insurance, to cover all FDA-approved contraceptive methods without cost sharing 1, 2. This means:

• Nexplanon, as an FDA-approved long-acting reversible contraceptive (LARC), should be covered with no copayment, coinsurance, or deductible payments
• This coverage includes both the device itself and the insertion procedure
• Studies show that out-of-pocket costs for all reversible contraceptives, including LARCs like Nexplanon, decreased sharply after the ACA contraceptive mandate 2

Nexplanon Effectiveness and Benefits

Nexplanon is a highly effective contraceptive option:

• It has a failure rate of only 0.05%, making it one of the most effective contraceptive methods available 3
• The implant is long-acting and reversible, lasting up to 3 years
• It can be used by women of all ages, including adolescents 3
• The American College of Obstetricians and Gynecologists recommends LARC methods like Nexplanon for their superior efficacy in preventing unintended pregnancy 4

Verification Steps

To confirm Nexplanon coverage under your specific Oscar Insurance plan:

1. Contact Oscar Insurance customer service directly
2. Check your online account portal for covered contraceptive options
3. Ask your healthcare provider to verify coverage before the insertion appointment
4. Request a pre-authorization if required by your specific plan

Important Considerations

While Nexplanon should be covered without cost sharing, be aware of these potential issues:

• Some grandfathered plans may be exempt from the ACA contraceptive mandate
• Religious employers may have exemptions from providing contraceptive coverage
• Coverage may vary for the removal procedure if done before the 3-year period ends
• If you encounter any issues with coverage, contact your state's insurance commissioner or the Department of Health and Human Services

Clinical Considerations for Nexplanon

When considering Nexplanon as a contraceptive option:

• Insertion can occur at any time if it is reasonably certain that you are not pregnant 4
• If inserted within the first 5 days of your menstrual cycle, no backup contraception is needed 4
• If inserted after day 5 of your cycle, you'll need to use backup contraception for 7 days 4
• Common side effects include unpredictable bleeding patterns, which is the most common reason for discontinuation 3
• Other potential side effects include emotional changes, weight gain, headache, and acne 3

The Society for Maternal-Fetal Medicine particularly recommends LARC methods like Nexplanon for women with comorbid conditions or pregnancy complications, as they provide superior protection against unintended pregnancies 4.