Which States have free Birth Control?

It’s been a bad year for reproductive healthcare. Trump has tried tirelessly to repeal and replace the Affordable Care Act with bills that would have led to millions of people losing their health insurance, let states withhold funding from family planning providers that offer abortion, and allowed employers to stop covering birth control altogether if they have religious or moral objections.

One of the big things Obamacare did was give people with health insurance free access to all contraceptive methods approved for women by the Food and Drug Administration—that’s all 18 types except for male condoms and vasectomies—as a preventive service. This includes on-the-fly methods like female condoms, planned ones like the Pill, long-acting reversible kinds like intrauterine devices (IUDs), and permanent methods like getting your tubes tied. In insurance-speak, this access is called “coverage without cost-sharing,” and it means that you don’t have to cough up co-pays or deductibles.

These Obamacare provisions reduce the barriers separating women from the most effective methods of birth control, and the fewer barriers there are, the better off we are. Studies suggest that once cost-sharing was eliminated, women were more likely to use the Pill consistently and more likely to use a prescription birth control method—especially long-acting ones, which are the most effective and the most expensive. Plus, complete coverage saves women $1.4 billion per year ($255 per person) on out-of-pocket expenses. That’s not accounting for additional costs you could face from getting pregnant when you don’t want to be. As a country, unintended pregnancies cost $24 billion a year in public health spending.

“Everyone deserves the ability to make informed decisions about their health and to control their bodies, which shouldn’t be dependent upon where they live, where they come from, or how they identify,” says Oregon Governor Kate Brown, who signed the state’s Reproductive Health Equity Act, one of the most progressive reproductive healthcare laws in the country, in August. “[This law] is so important as it brings down barriers around individuals’ health decisions and care, and contributes to overall greater public health.”

Even if Trump guts birth control coverage, states can put their own laws in place to require free reproductive and preventive healthcare. And that’s exactly what’s happening.

We’re facing a crisis here, where the attempts to repeal the Affordable Care Act are very palpable, very much on the front burner, and that includes repealing contraceptive coverage,” says Elizabeth Nash, the senior state issues manager at the Guttmacher Institute, an organization focused on advancing sexual healthcare around the world. “You're seeing [states] start to mobilize around protecting contraceptive coverage...Fundamentally, this is part of healthcare.”

In 2014, California became the first state to expand free access offered through Obamacare, and since then, several states have enacted similar laws, which we list below. Last week, Massachusetts became the latest state to guarantee contraception at no cost (no, not the first, despite what Facebook videos might tell you).

All of these laws guarantee that women with health insurance can get free birth control as prescribed by their doctor and they offer extended supply, which means you can walk out of the pharmacy with enough birth control to last for up to 12 months. Both rules make contraception more accessible. “The [state laws] are crafted in a way to eliminate those barriers to make it much easier to access contraceptives, and to be able to access the method that’s best for you,” Nash says.

But because the law is never straightforward or simple, each state has its own quirks. Some cover additional services like follow-up appointments, counseling on contraceptive use, and device insertion and removal for IUDs and implantable rods.

 

Are there any exceptions to this coverage?

Unfortunately, yes there are. From the start, the mandate accommodated religious nonprofits that objected to contraceptive coverage. In 2014, based on the case of Burwell v. Hobby Lobby, this exception included not only religious nonprofits but corporations with religious affiliations as well. Therefore, employers with religious affiliations could opt out of the birth control mandate, citing their religious beliefs. These employers had to notify the Department of Health and Human Services of their objection, and their insurance provider would then furnish separate payments to cover the costs of contraception for workers.

In October 2017, under the Trump administration, this exemption was expanded to allow almost any organization, not just religious ones, to opt out of the birth control mandate if they feel it violates their religious beliefs or moral convictions. The new rule also removes the provision requiring these employers to notify the government they are doing so. Now they’re only required to notify employees of a change in their insurance plan. Insurance companies can also refuse to cover contraception if it violates their religious or moral beliefs. Women employed at companies that are opting out will now have to pay for contraception out-of-pocket. And as expected, organizations and insurance companies without religious convictions have begun to take advantage of this loophole to avoid paying for birth control.

Another exception to the birth control mandate is grandfathered plans. Grandfathered plans are plans purchased before the enactment of the Affordable Care Act. Insurers who fall into this category can also opt out of birth control coverage. They don’t have to provide the new benefits, rights, and protections of the Affordable Care Act. If you are on a grandfathered plan, you can switch to a plan which covers birth control. If you need a particular kind of birth control, make sure that it is covered in some form by your new plan.

 

Insurance Coverage of Contraceptives
Jurisdiction	Coverage required for:					Prohibits cost sharing	Prohibits restrictions & delays	Refusal provisions
	Prescription methods	Over-the-counter methods	Extended supply	Male sterilization	Female sterilization			Scope	Enrollees notified by:
Federal	X	X			X	X		Broader§
Arizona	X							Expansive	Employer
Arkansas	X							Broader
California	Xᵝ	X (excludes male condoms)	X		X	X	X	Limited	Employer
Colorado	Xᵝ		X
Connecticut	X	X	X		X	X		Expansive*,†	Insurer
Delaware	X	X (excludes male condoms)	X		X	X	X	Expansive	Employer
District of Columbia	Xᵝ​	X	X		X	X	X	Expansive£​	Employer£​
Georgia	X
Hawaii	XӨ		X					Expansive†	Employer
Illinois	X	X (excludes male condoms)	X	X	X	X	X	Almost unlimited‡
Iowa	X
Maine	X		X		X	X		Broader	Employer
Maryland	Xᵝ	X (drugs only)	X	X		X		Expansive	Employer
Massachusetts	X	X (excludes male condoms)	X		X	X		Broader	Employer
Michigan	X							Broader
Missouri	X							Almost unlimited†,‡	Insurer
Montana	X
Nevada	X	X (only EC)	X		X	X	X	Expansive‡	Insurer
New Hampshire	XӨ		X			X
New Jersey	X	X (excludes condoms)	X	X	X	X		Broader	Employer
New Mexico	Xᵝ	X	X	X	X	X	X	Expansive
New York	X	X	X	X	X	X	X	Limited†	Employer/ insurer
North Carolina	X							Broader	Insurer
Ohio			€
Oregon	XӨ	X (excludes condoms)	X	X	X	X	X	Limited
Rhode Island	X		X					Broader	Employer
TennesseeӨ
Texas**
Utah	β
Vermont	X		X	X	X	X	X
Virginia	X		X€		X	X
Washington	Xᵝ	X	X	X	X	X	X
West VirginiaӨ​	X		X					Expansive†	Insurer
Wisconsin	X
TOTAL	29 + DC	12 + DC	20 + DC	8	14 + DC	16 + DC	9 + DC	20 + DC	15 + DC
Note: EC=emergency contraception. § Regulations that offered an almost unlimited religious and moral exemption are currently blocked by the courts. ‡ Refusal clause applies to insurers. ᵝ The state allows pharmacists to prescribe and dispense contraceptives, but insurance coverage of these services is not explicitly included in the law.* Religious insurers are not exempt from the mandate but may provide contraceptive coverage through a subcontract with another insurer or third-party entity. † Enrollees have the option of obtaining coverage directly from insurer. € The state’s law allows pharmacists to dispense the full amount of a prescription at one time, including contraception, but there is no requirement that health insurance plans cover the cost of accessing a year’s worth of contraceptives at one time. Ө The state explicitly includes coverage for contraception that is prescribed and dispensed by a pharmacist. ** Employers must be offered the option to include coverage of contraceptives within the health plan.

Here’s a list of states with laws that guarantee free access to birth control and in what scope. Healthcare is messy and complicated, so always check with your insurance provider to confirm what your plan covers. We’ll update this story as other states move to protect free reproductive healthcare.

California

Law: SB-1053, effective in January 2016; SB-999, effective in January 2017
Methods covered: all FDA-approved contraceptive drugs, devices, and other products for women as prescribed by your doctor; female sterilization
Extended supply: up to 12 months (that’s thanks to SB-999) 
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: This law says your insurance only has to cover costs for contraception if you have a prescription, but a separate law says you can buy self-administered methods—like the patch, the pill, shots, and vaginal rings—without a prescription. In these cases, your insurance should still cover the cost, but it’s best to check beforehand.

Vermont

Law: HB-620, effective dates from July 2016 to October 2016
Methods covered: at least one form of each FDA-approved contraceptive drug, device, and other product for women as prescribed by your doctor; male and female sterilization
Extended supply: up to 12 months
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: The only exclusion here is male condoms.

Illinois

Law: HB-5576, effective in January 2017
Methods covered: all FDA-approved contraceptive drugs, devices, and products; male and female sterilization
Extended supply: up to 12 months
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: Illinois’ law doesn’t apply to employers with self-insured health plans, but it does require insurance companies to cover a 12-month supply of contraceptives at once.

New York

Rule: Regulation 62, effective in August 2017
Services covered: at least one form of each FDA-approved contraceptive drug, device, and other product for women 
Extended supply: a three-month supply with first prescription, then a 12-month supply
Other services: device removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects; medically necessary abortions 
Pay attention to this: The regulation applies to plans regulated by the state, which includes plans sold to individuals, plans sold to companies with fewer than 100 employees, and plans that larger companies buy from insurance companies. Employers that are self-insured don’t have to follow the rule. There’s a bill in the state senate that would require coverage without cost-sharing, but as of November 2017, it hasn’t passed yet.

Law: HB-3391, effective dates from August 2017 to January 2019
Methods covered: any FDA-approved drug, device, or product; male and female sterilization 
Extended supply: a three-month supply with first prescription, then a 12-month supply, thanks to HB-3343
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects; abortions
Pay attention to this: Oregon is the first state to require insurance providers to cover the full cost of abortions with no exceptions, and anyone can get reproductive health coverage regardless of gender identity or citizenship status.

Nevada

Law: AB-249 and SB-233, both effective in January 2018
Methods covered: all FDA-approved contraceptive drugs, devices, and other products for women as prescribed by your doctor; female sterilization
Extended supply: a three-month supply with first prescription, then a 12-month supply
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: If you switch health insurance plans after getting an IUD or implant, the new insurance may charge you if/when you want it removed.

Maryland

Law: HB-1005 and SB-848, both effective in January 2018
Methods covered: all FDA-approved contraceptive drugs and devices as prescribed by your doctor; male and female sterilization; emergency contraception (even without a prescription)
Extended supply: a two-month supply with first prescription, then a six-month supply
Other services: none
Pay attention to this: Maryland was the first state to require coverage of over-the-counter emergency contraception without cost-sharing. Still, the law only applies to plans regulated by the state.

 

Maine

Law: HP-860, effective in January 2018
Methods covered: at least one form of each FDA-approved contraceptive drug, device, and other product for women as prescribed by your doctor
Extended supply: up to 12 months
Other services: none
Pay attention to this: Insurers are only required to cover one form of each method (e.g. one type of pill), but if your doctor says your method is medically necessary, it has to be free.

Massachusetts

Law: H-4009, insurers have until May 2018 to comply
Methods covered: all FDA-approved contraceptive drugs, devices, and products for women; female sterilization; FDA-approved emergency contraception (like Plan B)
Extended supply: a three-month supply with first prescription, then a 12-month supply
Other services: device insertion and removal; patient education and counseling on birth control use; follow-up services related to your birth control use, like help managing side effects
Pay attention to this: Massachusetts’ law doesn’t cover male condoms or FDA-approved birth control pills with no generic equivalent. Insurers aren’t required to cover brand name products when a generic is available unless your doctor says it’s medically necessary. The law also does not apply to self-insured employers.