Some birth control is completely free with no out-of-pocket cost, even before your deductible under all qualifying non-grandfathered plans, but not all birth control is free. If your plan covers birth control then at least one choice from each of the 18 above FDA approved categories must be offered with no cost-sharing (your insurer pays the full amount). If your plan is exempt, due to you having short term health insurance or a grandfathered plan, then your birth control services may not be covered. You can still try to get free coverage by using the tips we talked about.
Tips on getting free birth control:
- If you have a choice of medical insurance plans, try to get a plan which covers all types of birth control. If you need a certain kind, make sure that it is covered in some form, either generic or non-generic, on your plan. Often generics are free, but brand names aren’t. Look at each insurance company’s formulary (the list of drugs that it will cover) to see which drugs and/or brands are included. Different plans have different formularies, so if you need a specific brand of birth control, or any other medicine, and are choosing one health insurance provider from several choices, check the different formularies. It can make a large financial difference. Your pharmacy may be able to help you with this step, especially if you are selecting a Medicare supplement plan.
- Insurance companies can charge you a copay, coinsurance, or deductible for a brand-name drug if a generic version is available unless your provider determines there is a medical reason why you need the brand-name drug instead of the generic. Sometimes your insurance company will ask you to try the generic form first, even though you may have done so in the past when covered but another company. You and your doctor may have to appeal requests such as this.
- Make sure to have a prescription from your doctor. Often a prescription will be required to take advantage of birth control offered on your plan.
- Only women’s birth control is covered. Over the counter condoms are not covered, but you are likely to be able to find free condoms at various clinics and at community centers that focus on sexual health.
What Does “Free” Mean in Regards to Birth Control?
Free means that there is no cost-sharing on at least one method from each of the 18 FDA approved contraception categories. Cost-sharing refers to money you have to pay: copays, coinsurance, and other out-of-pocket costs owed by the insured (you). The insurer will cover the full cost of covered contraception even if you haven’t yet paid down your deductible.
The bottom line: Most, (but not all) plans cover all birth control and not all plans cover all birth control for free.