Close
Welcome! ( or )

Got health insurance? Hello, birth control options!

Full coverage of birth control under the Affordable Care Act should be kicking in right about…now.

UPDATE: The health insurance marketplace is officially open! If you haven't been able to afford insurance in the past, now is the perfect time to read up.


By Gretchen Borchelt of the National Women’s Law Center.

Has birth control ever given you sticker shock? Thanks to the new health care law, the Affordable Care Act (or ACA), if you have health insurance, your preferred birth control method should now be a covered benefit without any out-of-pocket expenses. You read that right: when you walk into the pharmacy to pick up a pack of pills, your receipt should say $0. Same deal when you go to a health care provider to get an IUD: $0.

But the devil’s in the details. The National Women’s Law Center is here to help sort through whether your plan has to provide this benefit, what types of birth control you should get access to, and what you can do if you have coverage but you’re still being charged co-pays or deductibles for birth control.

You should already be covered

This birth control benefit applies to all "new plans," but it doesn’t mean you have to switch to a different health plan to get this benefit. "New plan" just means a plan that has made changes since the health care law was passed. Most plans are already considered new. In other words:

  • If you have health insurance through your school, your birth control should be covered without co-pay.
  • If you have health insurance through your job, your parents, or your spouse, your birth control should be covered without co-pay.

If your plan existed before the health care law (March 2010) and has not made certain significant changes since then, it might be considered "grandfathered." Grandfathered plans don’t have to give you this benefit, so you might not get it until your plan makes changes and becomes ungrandfathered.* If you think your plan might be grandfathered, you should call your insurance company to ask.

Keep in mind: there are special rules for employers or schools with religious objections to providing birth control coverage. Find out more about those rules here.

You should be able to get the birth control that’s right for you—with no out-of pocket expense

Plans must cover all FDA-approved birth control methods with no out-of-pocket expense. That includes implants, IUDs, the shot, the pill, the patch, the ring, diaphragms, cervical caps, and sterilization procedures. (Birth control you can buy without a prescription probably won’t be covered under this law.)

For some types of birth control, there is only one option available in the United States, so plans should cover them; for example, Ortho Evra is the only patch and NuvaRing is the only ring, so they must be covered. But there are many kinds of pills, and many health insurance companies cover only some of them, so which pills are covered without co-pay will vary by plan.

Unfortunately some insurance plans are not following the law yet. At the National Women’s Law Center, we hear from women whose plans are only covering the pill, but not the ring or the patch. Other women have been told that only generic brands are covered, even when the brand-name drug they need doesn’t have a generic version. Health plans have been given some leeway to determine what is covered, but they should not be able to stop you from getting the birth control that is right for you.

The bottom line is that you have to call your insurance plan to find out whether your particular birth control is covered without out-of-pocket expenses. Here’s a guide to what to ask the human you eventually get on the phone, and what their answers mean for you.

The National Women’s Law Center’s CoverHer campaign

What can I do if my plan says they won’t cover my birth control?

If it seems that your plan is not following the law, don’t despair! The National Women’s Law Center will help you sort this out for free. Call our toll-free hotline (1-866-745-5487), email us at CoverHer@nwlc.org, or visit CoverHer.org to get started. We are working with women across the country who are having trouble getting their method covered without a co-pay. For example, we helped one woman who was told by her plan that she had a co-pay because only generic pills were covered—but her brand-name pill did not have a generic version. After we helped her protest, the plan agreed to cover her brand-name pill and all other brands that do not have generic versions.

Persistence pays

When you call your health insurance company, be persistent! You might have to call repeatedly to find out if the birth control method you want is covered. And don’t be afraid to ask for a supervisor—often the person answering the phone doesn’t have the correct information or know the law.

One woman called her plan over and over and was given bad information by several different people. Her determination paid off—she eventually got the "formulary list," a fancy name for a list showing exactly which types of birth control would be covered without co-pay.

And birth control isn’t the only benefit

The ACA also requires other women’s preventive health services and screenings to be covered in all new plans without out-of-pocket expenses. There’s a long list of covered benefits, but a few highlights are:

  • annual well woman visits
  • depression screening
  • intimate partner violence screening and counseling
  • counseling on sexually transmitted infections, including HIV
  • vaccines for HPV, the flu, and Hepatitis
  • a wide range of prenatal screenings and tests
  • breastfeeding counseling and supplies

It may take a while for all of these benefits to be implemented smoothly, but the bumps in the road will be small compared to the gains.

*If you live in one of the 26 states with its own state law requiring insurance coverage of birth control, your insurance plan might be required to provide this coverage already, although you will have to pay a co-pay or other cost-sharing.

Updated on September 5, 2014.


Gretchen Borchelt, JD, is Senior Counsel and Director of State Reproductive Health Policy at the National Women’s Law Center, where she’s been helping women get insurance coverage of birth control since 2005. She’s thrilled that—because of the new health care law—it’s becoming a reality for women across the country. When not fighting for policies that protect and expand reproductive health, she enjoys spending time with her two young daughters, who, it should be noted, were planned and spaced thanks to birth control.

My insurance plan switched in 2013 so that no prescriptions are covered until the deductible is met. After the deductible is met when they start using the co-payment amount. I technically don't have any out-of-pockets costs since my employer contributes enough to my HSA to cover my deductible, but it would be nice to have the extra $250 in there in case I had a real medical emergency.

2013-01-24 00:14:54 UTC

Jenny

Can't wait for 2014 to get here. I only pay $15 for birth control right now, which isn't much, but I'm a college student on my parents insurance, so any little bit of cash I can save for gas or something is super helpful.

2013-05-11 01:11:56 UTC

elmyrah

Thanks for this article! My insurance is refusing to cover my $80/month nuvaring prescription. It's encouraging to see others fight and win.

2013-09-10 02:16:15 UTC

Whitney

My insurance is BCBS of Alabama. They never did cover ANY birth control (but you can get Viagra!). My plan is grandfathered. I probably have no hope of getting my Depo shot covered, ever.

2013-12-03 21:17:35 UTC

Alison Widmer

I feel you!! From what I gather from this article, now that it's 2014 things should have all kicked in-- however, I tried to start the patch this week and cvs AND my MD says BCBS-AL won't pay a cent. Going to try negotiating with insurance if I can but I thought these issues were going to fade out this year.

2014-01-29 01:33:53 UTC

diana

Sorry to hear you're having trouble getting your birth control covered by your insurance. Our article on generic vs. brand name birth control might be of interest if your insurance providers say they cover some birth control options but not others: http://bedsider.org/features/314. We would also strongly recommend reaching out to the folks at the National Women's Law Center (pill4us@nwlc.org or 1-866-PILL4US). Even if they can't help you at this point, it's good for them to know how the different insurance providers are implementing--or not implementing--changes in response to the ACA. Best of luck!

2014-01-29 17:45:52 UTC

Bedsider Staff

Sorry to hear you're having trouble getting your birth control covered by your insurance. Our article on generic vs. brand name birth control might be of interest if your insurance providers say they cover some birth control options but not others: http://bedsider.org/features/314. We would also strongly recommend reaching out to the folks at the National Women's Law Center (pill4us@nwlc.org or 1-866-PILL4US). Even if they can't help you at this point, it's good for them to know how the different insurance providers are implementing--or not implementing--changes in response to the ACA. Best of luck!

2014-01-29 17:45:52 UTC

Bedsider Staff

I agree. The cost for my Ring is $96 AFTER my insurance. My doctor's office even contacted my insurance company, filled out a prior authorization form, and gave them all my past history and difficulties with other prescriptions, and they still refused!

2014-02-06 23:03:47 UTC

alexander66103 .

Can anyone explain why the cost of Ortho Try Cyclen Lo keeps skyrocketing? My insurance isn't great, but it's all I have right now. It barely covers 10 bucks! I'm paying out the wazoo for my birth control. And no, it doesn't have a generic anymore. And if it did, I've heard terrible things about Ortho's generics in the past. What can I do? I can't afford it every month.

2014-02-18 15:52:43 UTC

Samantha Meador

Can anyone explain why the cost of Ortho Try Cyclen Lo keeps skyrocketing? My insurance isn't great, but it's all I have right now. It barely covers 10 bucks! I'm paying out the wazoo for my birth control. And no, it doesn't have a generic anymore. And if it did, I've heard terrible things about Ortho's generics in the past. What can I do? I can't afford it every month.

2014-02-18 15:52:43 UTC

Samantha Meador

I have United Healthcare through my parents and my nuvaring is free. i've been thinking of switching to nexplanon though

2014-02-24 04:32:28 UTC

Guest

Has anyone had any success fighting this for NuvaRing? My insurance paid it IN FULL for 6 months and then all of a sudden last week it went back up to a $40 copay. I don't want to switch because it is the only one that doesn't give me side effects.

2014-06-18 23:35:29 UTC

Stephanie

If you go thru a pharmacy, Nuvaring offers a manufacturer's coupon to help with costs that gives 6-12 months of relief. The last time I used it I got half off my copay. You can always get a new coupon when time on the one you're using runs out!

2014-07-12 03:34:34 UTC

Lori

If you go thru a pharmacy, Nuvaring offers a manufacturer's coupon to help with costs that gives 6-12 months of relief. The last time I used it I got half off my copay. You can always get a new coupon when time on the one you're using runs out!

2014-07-12 03:34:34 UTC

Lori

ha hope my Insurance wont do that, as they refused to pay for a diaphragm claiming it wasn't medically necessary being I have not tried Nuvaring which is still hormonal birth control. I was trying to get away from the pill as it was making me dry & I have negative views on hormonal Birth control abortifacient property's. Im a person that would not be willing to use emergence or progesterone only hormonal birth control ever & am cautious to still use condoms when on comb birth control pills. anyway ill be trying nuvaring now for 3 months unless I hate it then hope my insurance will change there mind on covering the Diaphragm.

2014-07-31 07:17:26 UTC

Nicky L Boehlen

ha hope my Insurance wont do that, as they refused to pay for a diaphragm claiming it wasn't medically necessary being I have not tried Nuvaring which is still hormonal birth control. I was trying to get away from the pill as it was making me dry & I have negative views on hormonal Birth control abortifacient property's. Im a person that would not be willing to use emergence or progesterone only hormonal birth control ever & am cautious to still use condoms when on comb birth control pills. anyway ill be trying nuvaring now for 3 months unless I hate it then hope my insurance will change there mind on covering the Diaphragm.

2014-07-31 07:17:26 UTC

Nicky L Boehlen

ha hope my Insurance wont do that, as they refused to pay for a diaphragm claiming it wasn't medically necessary being I have not tried Nuvaring which is still hormonal birth control. I was trying to get away from the pill as it was making me dry & I have negative views on hormonal Birth control abortifacient property's. Im a person that would not be willing to use emergence or progesterone only hormonal birth control ever & am cautious to still use condoms when on comb birth control pills. anyway ill be trying nuvaring now for 3 months unless I hate it then hope my insurance will change there mind on covering the Diaphragm.

2014-07-31 07:17:26 UTC

Nicky L Boehlen

I also have BCBS and I was told they will cover $0 towards a new Mirena (I had to pay out of pocket for my first one, due to it being denied on BCBS). Should I trying arguing with BCBS again, or talk to the Dr to see if they will bill as "Preventive Care"?

2014-09-02 16:16:44 UTC

jess

can someone please tell me why Medicaid doesn't cover Minastrin 24 Fe? I need my pills and freaking out! what's the generic version?

2014-09-08 18:40:48 UTC

Saira

Great article. Thank you for helping me learn about these services I never knew about. I really want to get off of hormone birth control (NuvaRing) and switch to an IUD, but it's quite cost-prohibitive, right now. Now I have options! Thank you!

2014-09-10 17:18:39 UTC

Justin Staley

add new comment