Women with Disabilities Face Barriers to Contraception Due to Medicare Coverage Gaps

Gaps in Medicare coverage may be limiting access to contraception for people with disabilities, according to a new study published in JAMA Network Open. 

Women who are dually enrolled in Medicare and Medicaid are also significantly more likely to use contraceptives, pointing to financial barriers that continue to undermine reproductive autonomy.

Access to contraception is essential for reproductive health, yet women with disabilities face disproportionate obstacles.

In the U.S., they are 32% less likely than nondisabled women to use any contraceptive method, with cost being a major factor, the study highlighted.

In 2024, women with disabilities were more than twice as likely to stop using contraception due to affordability issues.

While Medicaid, private insurance under the Affordable Care Act, and the U.S. military's healthcare program TRICARE now cover all FDA-approved contraceptives without cost-sharing, Medicare remains a notable outlier.

As of 2025, the program covered about 1.5 million reproductive-aged women with disabilities, yet neither traditional Medicare (TM) nor Medicare Advantage (MA) plans are required to cover contraception for pregnancy prevention.

Although some short- and long-acting methods are offered with cost-sharing, permanent contraception is excluded—even when medically necessary. Coverage improves for the 60% of Medicare enrollees who also qualify for Medicaid.

In these dual-enrollment cases, Medicaid covers all contraceptives without cost-sharing.

The new study examines how gaining this additional coverage affects contraceptive use, shedding light on persistent inequities in Medicare’s reproductive health benefits.

However, insurance coverage is only one piece of the puzzle. Women with disabilities—especially those with cognitive disabilities—face systemic challenges beyond cost.

A study from the Heller School for Social Policy and Management found that these women are less likely than their nondisabled peers to receive formal sex education on key topics such as refusal skills, condom use, birth control access and STI prevention.

They are also more likely to experience nonconsensual or early sexual activity, often outside of steady relationships—making access to reliable contraception even more critical.

Physical and institutional barriers also interfere with care. Some physicians assume women with disabilities are not sexually active and may neglect to offer contraception or STI screenings.

Clinics may lack accessible equipment or staff trained in disability-related needs, further limiting access—even when insurance coverage exists.

In the JAMA study, researchers analyzed national Medicare and Medicaid claims data from 2016 to 2020 to examine how insurance type influences contraceptive use among women with disabilities.

Research focused on women aged 20 to 49 receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), excluding those who were pregnant, recently postpartum, had a hysterectomy or lacked complete data.

Monthly contraceptive use was tracked through claims for short-acting methods (e.g., pills, patches), long-acting methods (e.g., IUDs, implants), and permanent methods (e.g., tubal ligation).

The researchers compared usage across five insurance types: TM only, MA only, dual TM-Medicaid, dual MA-Medicaid and Medicaid only.

A difference-in-differences approach evaluated whether transitioning from Medicare-only to dual enrollment led to changes in contraceptive use.

The study analyzed over 51 million data points from more than 1.6 million women with disabilities, with an average age of 36. Most had mental health disabilities, followed by physical, intellectual/developmental (IDD), and sensory disabilities. Women in TM had the lowest contraceptive use (4.9%), followed by MA (6.6%), while those with Medicaid or dual coverage had higher usage rates—between 11% and 13%.

After gaining Medicaid coverage, contraceptive use increased from 8.6% to 11.9%, with both short- and long-acting method use rising.

Overall, dual coverage was associated with a 35% increase in contraceptive use within a year.

The increase was even higher—6.1 percentage points—for women with IDDs. These findings remained consistent even after accounting for COVID-19 and other variables, suggesting a clear link between expanded coverage and improved access.

This study highlights how Medicare’s limited contraceptive coverage contributes to care gaps.

Gaining dual enrollment with Medicaid led to a 3.9 percentage point increase in contraceptive use—representing nearly 14,000 additional users.

Based on these results, the authors recommend that CMS eliminate cost-sharing for all prescription contraceptives in Medicare.

Even inexpensive options may be out of reach for women living on SSDI, who average just over $1,200 per month.

They also call on Congress to mandate coverage of permanent methods like tubal ligation, which are currently excluded. Yet better coverage alone isn’t enough.

Many women with disabilities still encounter gaps that affect their reproductive rights.

Achieving equitable access also requires training providers in disability-inclusive care and ensuring that all patients receive unbiased, person-centered contraceptive counseling.