Is it True That Health Plans are Now Required to Cover Birth Control for Free?

You will be able to get your birth control at no out-of-pocket costs, as the full cost will be covered by your monthly premium.*

The Affordable Care Act covers one type of birth control per person from each of 18 FDA approved categories at no out-of-pocket cost, although some plans have exemptions. This page will tell you what kinds of birth control are covered, which health plans have exemptions, how to get free birth control under the Affordable Care Act, and how to get help even if you don’t have insurance.

Under the ACA at least 67% of insured women on the pill were projected to be paying $0 for it in 2014 (up from only 15% in 2012).

 

The bottom line: When you visit your health care provider about birth control and when you get it from a pharmacy, you should not have to pay anything at that time

The full range of FDA-approved contraceptive methods, including oral contraceptives (the pill), injectables, the ring, contraceptive implants, diaphragms, and cervical caps.* Sterilization for women is also covered. For greater detail and further explanation, please see the Department of Health and Human Services’ “Frequently Asked Questions” and our explanation.

 

What Birth Control Is Covered?

According to HealthCare.Gov Food and Drug Administration-approved contraceptive methods prescribed by a woman’s doctor are covered. This generally includes:

• Barrier methods (used during intercourse), like diaphragms and sponges
• Hormonal methods, like birth control pills and vaginal rings
• Implanted devices, like intrauterine devices (IUDs)
• Emergency contraception, like Plan B® and ella®
• Sterilization procedures
• Patient education and counseling

Plans aren’t required to cover:

• Drugs to induce abortions
• Services related to a man’s reproductive capacity, like vasectomies

The 18 Contraception Categories

Under the Affordable Care Act non-grandfathered plans must cover specified recommended preventive care services without cost sharing, consistent with PHS Act section 2713.

The 18 types of contraception are:

• Sterilization surgery
• Surgical sterilization implant
• Implantable rod
• Copper intrauterine device
• IUDs with progestin (a hormone)
• Shot/injection
• Oral contraceptives (the pill), with estrogen and progestin
• Oral contraceptives with progestin only
• Oral contraceptives, known as extended or continuous use that delay menstruation
• The patch
• Vaginal contraceptive ring
• Diaphragm
• Sponge
• Cervical cap
• Female condom
• Spermicide
• Emergency contraception (Plan B/morning-after pill)
• Emergency contraception (a different pill called Ella)

 

Unless the use of a name brand is a medical necessity, generics will be covered with no out-of-pocket costs. Not all plans offer all types of contraception, but a recent clarification by HHS has ensured that at least one type from each of the above categories will be covered on all qualifying plans.

What Plans Don’t Have to Cover Birth Control

As of July 2015 all plans, except for the following, must provide at least one method from each of the 18 FDA approved birth control categories at no out-of-pocket costs:

• Religious employer health plans (houses of worship don’t have to provide coverage. For all other religious employers women are provided contraceptive coverage through a third party).
• Grandfathered health plans (plans purchased before March 23, 2010)
• Short Term health insurance
• Alternative plans offered by insurers that specifically exclude some forms of birth control (each exchange is supposed to offer at least one plan that doesn’t provide coverage for controversial contraception).

All non-exempt plans cover basic birth control, but only some specific plans cover all birth control types. The rule is that each of the 18 FDA approved categories has to be covered by at least one drug or service, not that everything related to contraception must be covered. Plans that were “grandfathered in” before the new ACA protections kicked in may be exempt from offering contraception for free. This includes some group health plans. In addition, short term health insurance does not have to provide contraception.

Religious Employer Exemptions and Non-Profit Religious Exemptions

Some “religious employers”, houses of worship, health sharing ministries, a few employers who got religious exemptions, non-profit hospitals, some institutions of higher education, etc don’t have to provide contraceptive services, including counseling. However, after a rule passed by the Obama administration in July of 2015 employees of religious employers are provided with free contraceptive coverage through a third party in most cases. Houses of worship are exempt from this rule and health sharing ministries are unaffected by this rule as they are not employers.

If you work for an exempt religious employer and use contraceptive services, you may have to pay for them out-of-pocket or seek low cost options through clinics or Planned Parenthood. Contact your employer or benefits administrator so that you know what your personal coverage is.

Some non-profit institutions with exemptions don’t have to contract, arrange, pay, or refer for contraceptive coverage, They do not prevent you from using an insurer or third party administrator to make separate payments for contraceptive services that you use (even if the new rule for employers doesn’t apply to that institution). So if the entity you get coverage through is exempt from the requirement to provide contraception you may have options.

Is all Contraception Free Under ObamaCare?

You can expect to pay for some sorts of birth control on almost all plans (for example: a plan may only cover generics or may have a copay for a certain birth control type). Also some plans are exempt from providing any contraceptive coverage as we have discussed.

Some employers and institutions were exempt due to religious objections for a short period of time after a Hobby Lobby lawsuit, however a new rule issued by the Obama administration has provided free contraceptive coverage through a third party so employees still has access to birth control at exempt employers (this is true for all religious employers except houses of worship). In a health sharing ministry you can be kicked off the plan for accessing contraceptive services and grandfathered plans and short term plans don’t have to cover contraception at all.

Depending on the particular plan, your coverage without cost-sharing may expand to include contraceptive services when using an in-network provider.

• Prescription – One or more products within the categories approved by the FDA for use as a method of contraception

• Over-the-counter – Contraceptives available over-the-counter approved by the FDA for women (foam, sponge, female condoms) when prescribed by a physician

• The morning after pill

• Medical devices such as IUD, diaphragm, cervical cap and contraceptive implants

• Female sterilization including tubal ligation*

* Certain restrictions may apply; you might have to pay a copay, coinsurance or deductible in some cases – refer to your plan materials or contact us for more information. Hysterectomies are not considered part of the women’s preventive care benefit.

How to Get Free Birth Control

If you have Medicaid, an employer plan, or an individual or family plan sold after 2010 at least one type of birth control from each of the 18 FDA approved categories is covered for free (at no out-of-pocket cost sharing before your deductible).

You can get prescriptions for free birth control from:

• Private and Public Health centers including community health centers, walk in clinics, and Planned Parenthood.
• A Family Doctor
• A Hospital specifically in cases where emergency birth control is needed.

Prescriptions can then be filled in the facility or at a local pharmacy. Some birth control, like spermicide, can be sold over the counter and can be purchased at a local pharmacy. Emergency birth control like plan B may be covered without a prescription.

TIP: Make sure to check with your insurer first to understand what birth control is covered under your plan.

What If I Don’t Have Insurance?

If you don’t have insurance and you have low income you may be able to access free women’s health services including birth control at public health centers, from organizations like Planned Parenthood, and from private health centers that offer assistance.

If you don’t have coverage and can’t get free birth control due to income you can often get very cheap generics at your local major pharmacy by paying cash and letting the pharmacist know you don’t have health insurance. You can also try looking into free RX cards offered online.

If you don’t have coverage due to income make sure to look into Medicaid / CHIP and cost assistance options.

$0 Contraceptive Benefits Covered

CERVICAL CAPS

FEMCAP

PRENTIF CAVITY-RIM CERVICAL CAP

PRENTIF FITTING SET

DIAPHRAGMS

OMNIFLEX DIAPHRAGM

ORTHO ALL-FLEX

ORTHO COIL SPRING KIT

ORTHO FLAT SPRING KIT

WIDE-SEAL SILICONE

EMERGENCY CONTRACEPTIVES**

levonorgestrel

My Way

Next Choice/One Dose

INJECTIONS

DEPO-PROVERA CONTRACEPTIVE (generic available)

DEPO-SUBQ PROVERA 104

medroxyprogesterone acetate

IMPLANTABLE

IMPLANON

NEXPLANON

INTRAUTERINE

MIRENA

PARAGARD

SKYLA

PATCH

ORTHO EVRA

RING

NUVARING

ORAL CONTRACEPTIVES

Camila

Errin

Heather

Introvale

Jencycla

Jolessa

Jolivette

levonorgestrel/ethinyl estradiol (91 day)

Lyza

Nora-BE

norethindrone

norgestimate/ethinyl estradiol (generic for Orthro Tri-Cyclen)

Quasense

Trinessa

Tri-Estarylla

Tri-Linyah

Tri-Previfem

Tri-Sprintec

* Prescription coverage for contraception may vary according to the terms and conditions of the plan

** A prescription is required for emergency contraceptives to be covered without cost-sharing under the pharmacy benefit for non-grandfathered plans

Affordable Care Act regulations provide for an exemption from the requirement to cover contraceptive services for certain group health plans established or maintained by organizations that qualify as religious employers. Also, federal regulatory agencies have established an accommodation for religious affiliated eligible organizations, in which case separate payment may be available for certain contraceptive services. For more information about the religious employer exemption or eligible organization accommodation, please contact us at the phone number on your member ID card.

Generic Drugs = bold

Brand Drugs = CAPITAL LETTERS