UPDATE: The open enrollment period for 2016 is over, but you may still be able to get coverage. Find out if you could be eligible for special enrollment.
By Gretchen Borchelt of the National Women’s Law Center. Last updated on December 23, 2014.
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. It also includes birth control that you can buy over-the-counter—like the sponge, the internal condom, and some emergency contraceptives—but to get coverage, your plan might require you to have a prescription from your health care provider.
For some types of birth control, there is only one option available in the United States, so plans should cover them; for example, NuvaRing is the only ring, so it 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.
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.
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.
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.