What is it?
Did you know that before the Affordable Care Act (ACA), up to 44% of women's out-of-pocket health care spending went toward contraceptives? As of August 1, 2012, the ACA mandated that all new commercial health insurance plans in all states cover a comprehensive list of FDA-approved birth control methods without charging patients anything.
This comprehensive list covers the 18 FDA-approved methods of birth control, including oral contraceptives, vaginal rings, cervical caps, IUDs, implants and even sterilization. Under the ACA, health plans must cover at least one product in each category. However, plans aren't required to cover services related to a man's reproductive capacity, like vasectomies.
The contraceptive mandate has been a great development in women’s health across the US. Reducing out-of-pocket costs for birth control has been associated with improved adherence and a lower unintended birth rate. A recent study showed that the ACA contraceptive mandate may be associated with lower income-related disparities in unintended birth rates. There are some limitations to be aware of as you navigate your health journey.
Health plans are not required to cover every single method of contraception. In fact, many new methods aren’t part of the mandate, even if they are approved by the FDA. For example, Phexxi, a gel that regulates vaginal acidity to reduce the odds of sperm reaching an egg, was approved by the FDA last year but health plans are not required to provide the product free of charge. That means you could be on the hook for more than $250 for a box of 12 single-use applicators. Also out of scope are fertility-awareness apps recently approved by the FDA such as Natural Cycles.
Further, some health plans aren’t required to follow the contraceptive mandate at all. Plans provided by churches and religious nonprofits, as well as employers and schools that object to contraception due to a “sincere religious or moral objection,” are examples. Additionally, some older plans were “grandfathered in” under the law and are also exempt. If you don’t have or use insurance, then you also don't benefit from the mandate.
Lastly, plans sometimes make it difficult to access certain contraceptives, even those on the list of approved drugs. Some common ways this happens is when health plans require “prior authorization,” which means that healthcare providers have to provide documentation to the plan to prove that the product is medically necessary for the patient. Health plans may also cover a specific method or brand, but still require cost-sharing.
Know Your Rights
Because of the ACA’s contraceptive mandate, most health insurance plans must cover birth control and other important women’s health needs at no additional costs to you. If a doctor or other health care provider determines that you need a particular contraceptive, even if it's not on the list of approved products for your plan, your insurer is required to have an expedient process for you to seek a waiver. If you run into trouble, you can file an appeal with your insurance provider. If you think you’re incorrectly required to pay out-of-pocket for your birth control, you can call the CoverHer hotline at 1-866-745-5487.