If you have followed the news in the last several years, chances are you have heard some-thing about the Affordable Care Act (ACA), nicknamed Obamacare. Regardless of one's political affiliation or personal opinions about the law, it is something that will impact the health care of your entire family. One particularly controversial aspect of the ACA is its requirement for insurance coverage of contraception, something relevant to women of childbearing age (and their partners) everywhere, so it is important to educate yourself about how it may change your coverage now and in the coming years. Still, deciphering the confusing language and weeding through the controversy surrounding this hot-button topic can be difficult and downright frustrating. Here are basic facts about what will be covered, the cost to you, and what to do if you think you are wrongly being denied coverage.
What types of contraception are covered?
According to the government website healthcare.gov, virtually all conventional methods of birth control are covered by the plan, which means you won't have to give up your favorite method for something else just to receive coverage. According to the site, all Food and Drug Administration-approved contraceptive methods prescribed by a woman's doctor are covered, including:
- Barrier methods (used during intercourse), such as diaphragms and sponges
- Hormonal methods, such as birth control pills and vaginal rings
- Implanted devices, such as intrauterine devices (IUDs)
- Emergency contraception, such as the brand names Plan B and Ella
- Sterilization procedures for women
- Patient education and counseling
Plans aren't required to cover:
- Drugs to induce abortions
- Services related to a man's reproductive capacity, such as vasectomies
What do I have to pay?
Under the new plan, the above-listed contraception is fully covered by most health insurance policies with no additional cost to you. That means no co-pay, co-insurance, or deductible. However, while health insurance companies are not allowed to determine which methods of contraceptives they will cover, they are allowed to choose which brands are fully covered. For instance, if you prefer a brand-name birth control pill over a generic version, your company can still charge a co-pay, while you could get the generic of that pill for free. But if your doctor says it's unsafe for you to switch to a generic version, the co-pay will be waived. Additionally, if your insurance is an HMO, PPO, or POS plan, any services you need to obtain your contraceptives (i.e. a gynecological visit, implantation or removal of an IUD, etc.) must be conducted by an in-network provider in order to be covered by the plan. For any services that are out-of-network, you may have to pay a portion of the cost unless there are no in-network providers who can perform the service in your area. Confused yet? Simply put, as long as you see a doctor who is in-network and use medications and devices that are approved or generics, your birth control is covered by insurance with no additional cost to you. If you choose to go out-of-network or stick to a name-brand contraception that is not covered, you may incur out-of-pocket expenses.
Are there any exceptions?
Of course! Aren't there always exceptions? Plans that were "grandfathered" in, meaning they were in effect prior to the enactment of the ACA, do not have to follow all guidelines as long as they do not make significant changes—such as drastic cuts in benefits or increases in co-payments, coinsurance, or deductibles—which could cause them to lose their grandfather status. Eventually, all plans will lose their grandfather status and be required to abide by all laws in place, but for now, some are still operating under their old plans. Other health plans that are exempt from covering birth control include self-funded student health plans and plans at religious organizations, such as churches. Much controversy has swirled around which groups qualify for the religious exemptions to the contraceptive mandate. Some lawsuits have made it to the U.S. Supreme Court, so it is possible that details will continue to be modified in an effort to find compromise between the goal of making contraception more widely accessible and the concerns of some employers who do not want to cover any contraception or who object only to certain methods that might take effect after fertilization.
What about condoms?
Currently, the ACA does not apply to contraception used by men, including condoms or vasectomies. However, any over-the-counter contraceptives used by women can be covered as long as they are approved by the FDA, which would cover items such as female condoms and spermicides. But the law also states OTC products must be prescribed by your doctor, which may make it more cumbersome to obtain coverage. At this time, is unclear if, and how easily, you could be reimbursed for OTC products purchased at a drugstore.
Also, while some so-called "morning-after pills" are approved by the FDA and covered as a contraceptive method, abortion drugs are not approved and not covered by insurance plans under the ACA.
What if I have problems getting my birth control covered?
As to be expected when a new program of this size is rolled out, hitches may occur. A study by the Guttmacher Institute concluded that some private health plans are not adequately following the law. The law clearly states that all FDA-approved methods of female contraception are covered, yet some insurers are still not providing full coverage for certain methods such as contraceptive rings, patches, and IUDs. Women who prefer a hormonal patch, for instance, are paying a co-pay, while they could get hormonal birth control pills with no out-of-pocket cost. Insurance companies contend that because patches use the same ingredients as the pills, the methods perform essentially the same function; however, the FDA maintains that the delivery is different so both deserve coverage. Supporters of full coverage say that charging more for one method over another infringes on women's rights to choose the type of birth control method they prefer.
If you believe you have been charged for contraceptives that should be fully covered under the new law, contact your insurance company to clarify your benefits. The National Women's Law Center urges women who believe they've been wrongly denied coverage to speak with their insurance provider right away. In their toolkit, they offer a handy script to help you ask the questions using "insurance speak" so you won't feel intimidated or worried about asking the wrong questions. If all else fails, NWLC tells women they should file an appeal if they still feel they are being wrongly denied coverage, and NWLC's toolkit walks them through the process of an appeal.