Mirena and Paragard are the two most widely prescribed intrauterine devices in the United States, together covering the hormonal and non-hormonal ends of the long-acting reversible contraceptive market. Mirena, made by Bayer, releases levonorgestrel and is FDA-approved for up to eight years of pregnancy prevention plus treatment of heavy menstrual bleeding. Paragard, made by CooperSurgical, is a copper intrauterine device with no hormones, approved for up to 10 years. Bayer also sells two lower-dose hormonal IUDs, Kyleena and Skyla, and the nonprofit Medicines360 sells Liletta, a lower-cost hormonal alternative to Mirena distributed mainly through public health clinics.
Insurance coverage drives the real 2026 price far more than the device itself does. Under the Affordable Care Act's preventive services mandate, most non-grandfathered private health plans and every state Medicaid program must cover FDA-approved contraceptives, including all five IUD brands, at $0 copay with no deductible. Patients without ACA-compliant coverage face the full cash price of the device plus a separate clinic fee for insertion. This guide breaks down the 2026 cash price, the Bayer manufacturer patient assistance program, Medicaid family planning rules, and what to do if an insurer bills a patient for a device that should be free.
Federal Title X family planning clinics add a third path that most drug-cost guides skip. Clinics receiving Title X funding provide IUDs free to patients at or below the federal poverty level and on a sliding scale up to 250 percent of the federal poverty level, regardless of insurance status. Patients comparing costs should also check their state's Medicaid income limits and confirm whether their plan classifies the device under the medical benefit, billed with a HCPCS J-code, or the pharmacy benefit, billed like a prescription with a formulary tier, because that classification changes which cost-sharing rules apply.
What IUD Costs by Point of Pay (2026)
The price you pay depends almost entirely on WHERE you pay. The same iud can cost many times more at a hospital than at your local pharmacy:
2026 IUD Price by Point of Pay| Where you pay | Typical cost | Notes |
|---|
| Pharmacy or specialty pharmacy (cash, device only) | $900 - $1,350/device | 2026 cash price without insurance; the clinic bills the insertion procedure separately, typically $150 to $500. |
| ACA-compliant commercial insurance | $0 copay for device and insertion | Required by the ACA preventive services mandate for non-grandfathered plans in 2026; confirm your plan is not grandfathered before scheduling. |
| Medicaid (family planning benefit) | $0 - $3/device | Federal Medicaid rules bar cost-sharing for family planning services in nearly every state; check your state's Medicaid income limits before applying. |
| Bayer manufacturer assistance (Mirena, Kyleena, Skyla only) | Free if household income is at or below 300% FPL in 2026 | Paragard has no manufacturer patient assistance program; uninsured patients should ask about Title X clinics or Liletta instead. |
| Title X family planning clinic (sliding scale) | $0 - full cash price, based on income | Free at or below the federal poverty level; sliding scale up to 250% FPL in 2026, independent of insurance status. |
Device-only cash prices reflect 2026 GoodRx and SingleCare pharmacy pricing. Insertion and removal are billed separately by the clinic under CPT code 58300 or 58301.
Source: CMS ACA preventive services rule, HHS Office of Population Affairs Title X program, Bayer US Patient Assistance Foundation, GoodRx/SingleCare 2026 pharmacy pricing
Why Hospitals Charge So Much
Outpatient hospital and hospital-owned clinic bills for IUD insertion routinely separate three line items: the device itself, a facility fee for the procedure room, and a physician or advanced-practice clinician fee for the insertion under CPT code 58300. A patient who looks only at the total can mistake a $2,500 combined bill for the device price, when the device itself runs $900 to $1,350 and the remainder is facility overhead. Hospital-owned clinics generally charge higher facility fees than independent physician offices or community health centers performing the identical procedure, sometimes two to three times more for the same device and the same 15-minute insertion visit.
Bayer, CooperSurgical, and Medicines360 sell the physical device to the clinic or pharmacy at a wholesale price, then the clinic or pharmacy marks up the device line item and adds its own procedure charges on top. Patients who receive a bill above $1,500 for the device alone, separate from any facility fee, should request an itemized statement listing the HCPCS code (J7298 for Mirena, J7300 for Paragard, J7296 for Kyleena, J7297 for Liletta, or J7301 for Skyla) and compare it against the wholesale acquisition cost, which ran near $1,270 for Mirena and $1,190 for Paragard as of 2026.
HCPCS J-Codes: What Appears on Your Bill
Insurers and clinics bill IUDs under HCPCS Level II J-codes when the device is processed through the medical benefit rather than the pharmacy benefit. Each brand carries its own code.
HCPCS J-codes for IUD| Code | Description | What to look for |
|---|
| J7298 | Mirena, 52 mg levonorgestrel-releasing intrauterine system | Confirm this exact code, not a generic unlisted-device code, appears on your explanation of benefits; unlisted codes often trigger manual pricing and higher patient responsibility. |
| J7300 | Paragard, copper intrauterine device (T 380A) | Check that the claim also lists CPT 58300 for insertion; billing the device alone without the insertion code can delay ACA $0 cost-sharing processing. |
| J7296 | Kyleena, 19.5 mg levonorgestrel-releasing intrauterine system | Kyleena is a lower-dose Mirena alternative; confirm your plan did not substitute the higher-cost Mirena code in error. |
| J7297 | Liletta, 52 mg levonorgestrel-releasing intrauterine system | Liletta is priced far below Mirena at public health clinics; verify the clinic billed the Liletta-specific code and not J7298. |
| J7301 | Skyla, 13.5 mg levonorgestrel-releasing intrauterine system | Skyla is the lowest-dose, shortest-duration (3-year) hormonal IUD; confirm the duration and dose match what was actually inserted. |
CMS has not published a Medicare Part B Average Sales Price for J7298 or J7300 as of the third quarter of 2026, so Medicare pays these codes on a carrier-priced or invoice basis rather than the standard ASP-plus-6-percent formula, and only when the device is medically necessary for a non-contraceptive indication.
Source: CMS HCPCS Level II code set, CMS Medicare Part B ASP Pricing Files
Patient Assistance Programs
Bayer, the manufacturer of Mirena, Kyleena, and Skyla, runs an income-based patient assistance program for uninsured and underinsured patients. Paragard's dedicated manufacturer program ended in 2014; CooperSurgical now directs self-pay patients to an installment payment plan instead. Liletta, sold by the nonprofit Medicines360, is not distributed through a traditional PAP but is priced near cost for safety-net clinics.
Patient assistance programs for IUD| Manufacturer program | Cost / Benefit | How to apply |
|---|
| Bayer US Patient Assistance Foundation | Free Mirena, Kyleena, or Skyla for uninsured or underinsured patients at or below 300% of the 2026 federal poverty level | patientassistance.bayer.us |
| ParaGardDirect (CooperSurgical) | 4- or 12-month self-pay installment plan for Paragard when insurance does not cover the device | 1-877-PARAGARD / paragarddirect.com |
| Liletta 340B and safety-net pricing (Medicines360) | Liletta priced at $50 per device for 340B-enrolled public health clinics, versus $1,200 or more for Mirena at the same clinic | medicines360.org |
| Title X National Family Planning Program | Free or sliding-scale IUD, any brand the clinic stocks, at HHS-funded clinics based on income, independent of insurance status | opa.hhs.gov/title-x-family-planning |
| NeedyMeds Contraceptive Assistance Directory | Directory of state and local low-cost or free contraceptive programs, including IUD-specific clinics | needymeds.org |
Manufacturer coupons for chronic-disease drugs do not have a direct equivalent for IUDs, since the device is billed once rather than refilled monthly, but the same federal anti-kickback statute (42 U.S.C. Section 1320a-7b) that blocks manufacturer copay cards for Medicare, Medicaid, TRICARE, and VA beneficiaries on other drugs applies to any commercial discount offer here too. Patients with government insurance should use the income-based Bayer US Patient Assistance Foundation, a Title X clinic, or Liletta safety-net pricing rather than any manufacturer discount aimed at commercially insured patients.
Source: Bayer US Patient Assistance Foundation, CooperSurgical ParaGardDirect, Medicines360, HHS Office of Population Affairs Title X program, NeedyMeds.org
Medicare Part D
Traditional Medicare rarely covers IUDs, because Medicare Part B does not pay for contraception used solely to prevent pregnancy. Medicare Part B will cover Mirena, Kyleena, Skyla, or Paragard on a case-by-case basis when a prescriber documents a non-contraceptive medical reason, such as treating endometrial hyperplasia or heavy menstrual bleeding with Mirena, and standard cost-sharing (the 2026 Part B deductible of $283 plus 20 percent coinsurance) still applies to that claim.
Medicare Advantage plans occasionally add contraceptive coverage as a supplemental benefit beyond what Original Medicare covers, so beneficiaries under 65 who qualify for Medicare through disability should check their plan's evidence of coverage directly. Dual-eligible beneficiaries who also have Medicaid get the device through the Medicaid family planning benefit at $0 to $3, regardless of what Original Medicare pays. Because IUDs are billed through the medical benefit rather than the Medicare Part D pharmacy benefit, the 2026 Part D annual out-of-pocket cap of $2,100 generally does not apply to this device.
Common IUD Billing Errors
Patients who receive an IUD bill above $200 with ACA-compliant insurance, or any bill at all with Medicaid, should check for these issues before paying:
- An ACA-compliant plan charges a copay or deductible for the device or insertion despite the federal preventive services mandate requiring $0 cost-sharing; ask the plan for a written explanation citing the specific exception (grandfathered status or a religious exemption) before paying.
- A plan wrongly requires prior authorization before approving the IUD; ACA-compliant plans generally cannot require prior authorization for a preventive contraceptive service, though some plans still impose it in error and delay the insertion appointment as a result.
- An insertion visit billed at a hospital-owned clinic facility rate when the same visit at an independent OB-GYN office or community health center would carry a lower facility charge; ask whether the clinic is hospital-owned before scheduling.
- The wrong HCPCS code used, for example Kyleena or Skyla billed under Mirena's J7298, which can trigger a higher patient responsibility or a claim denial for a coverage mismatch.
- The device and insertion billed as two separate claims processed under different benefit types, medical versus pharmacy, causing the deductible to apply to one claim even though the ACA mandate should zero out both.
- Removal and same-visit reinsertion of a new IUD billed as two full separate procedures instead of the correct combined coding, doubling the facility fee unnecessarily.
Frequently Asked Questions
How much does an IUD cost without insurance in 2026?
Mirena, Kyleena, Skyla, and Paragard each cost between $900 and $1,350 for the device alone in 2026, according to GoodRx and SingleCare pharmacy pricing. The clinic bills insertion separately, typically $150 to $500 using CPT code 58300. Total cash cost without any coverage or assistance usually lands between $1,050 and $1,850. Uninsured patients should ask about Title X clinics, Liletta's discounted pricing, or the Bayer US Patient Assistance Foundation before paying full price.
Is there a generic version of Mirena or Paragard?
No. Neither device has an FDA-approved generic, because generic drug approval does not apply the same way to implanted devices, and no biosimilar pathway exists for non-biologic devices either. Liletta functions as a lower-cost brand alternative to Mirena, using the same levonorgestrel dose, and is priced as low as $50 for 340B-enrolled public health clinics. Paragard has no lower-cost brand alternative; it remains the only copper IUD sold in the United States.
How do I apply for the Bayer US Patient Assistance Foundation for Mirena, Kyleena, or Skyla?
Call 1-866-228-7723 or visit patientassistance.bayer.us to request an enrollment form. Have the prescriber complete the physician section confirming the prescription, then submit proof of household income (a tax return or two recent pay stubs) showing income at or below 300 percent of the 2026 federal poverty level. Households under 150 percent FPL must also submit proof they applied for or were denied the Medicare Low-Income Subsidy. Approved applicants get the device shipped free to the prescriber's office; the insertion visit fee is not included.
Can I use a manufacturer coupon for an IUD if I have Medicare or Medicaid?
No. Federal anti-kickback law bars manufacturer copay coupons and commercial savings offers from being used by anyone with Medicare, Medicaid, TRICARE, or VA benefits, the same rule that applies to drug savings cards. In practice this rarely matters for IUDs, since Medicaid already covers the device at $0 to $3 under the family planning benefit and Bayer's assistance program for Mirena, Kyleena, and Skyla is income-based rather than a commercial coupon. Medicare beneficiaries without Medicaid should ask the prescriber about a non-contraceptive medical necessity code instead.
Does the Inflation Reduction Act's Maximum Fair Price apply to Mirena or Paragard?
No. The Inflation Reduction Act's Medicare drug price negotiation program applies only to high-spend drugs covered under Medicare Part B or Part D, and CMS has not selected any IUD for negotiation. IUDs are billed as medical-benefit devices, not Part D prescriptions, so they fall outside the Maximum Fair Price framework entirely. The bigger cost lever for IUDs is the ACA's $0 cost-sharing mandate for contraceptives, not IRA negotiation.
What if my insurance denies coverage or bills me for an IUD that should be free?
First, request a written denial notice and confirm whether the plan is grandfathered under the ACA, since grandfathered plans, mostly older employer plans, are exempt from the $0 contraceptive mandate. If the plan is non-grandfathered and still charged for the device, file a formal appeal within the plan's deadline, usually 180 days, citing the ACA preventive services requirement. If the appeal is denied, file an external review through the state insurance department, and consider a complaint to the HHS Office for Civil Rights.
Do I qualify for the Bayer patient assistance program for Mirena?
A patient likely qualifies if uninsured or the insurance does not cover Mirena, Kyleena, or Skyla, is a US resident, and household income is at or below 300 percent of the 2026 federal poverty level, which is $47,880 for one person or $99,000 for a family of four. Households under 150 percent FPL must first show they applied for or were denied Medicare Extra Help. Paragard is not eligible for this Bayer program since CooperSurgical, not Bayer, manufactures it.
What is the difference between Mirena, Paragard, Kyleena, Liletta, and Skyla?
Mirena, Kyleena, Skyla, and Liletta are all hormonal IUDs that release levonorgestrel, differing mainly in dose and approved duration: Mirena and Liletta are the highest-dose, 8-year devices; Kyleena is a mid-dose, 5-year device; Skyla is the lowest-dose, 3-year device. Paragard is entirely different, a non-hormonal copper IUD approved for up to 10 years. Liletta is priced far below Mirena at public clinics despite being clinically similar. The prescriber picks the brand based on medical history, desired duration, and whether hormones should be avoided.
