Is birth control covered under the Affordable Care Act?

Before the birth control mandate, many insurers did not cover contraceptives for women, which often meant they were unaffordable or out of reach. Since the mandate came into effect the number of women with out-of-pocket expenditures on contraceptives dropped from 21% to 3%. What most people understand about the mandate is that birth control became free. But is this really true? And if it is, how does it affect you? Here’s all you need to know about the birth control mandate and what it means for you.

— Before you read on, we created a FREE printable that highlights the different forms of birth control. Grab it here to find out which one is best for you. —

First of all, how much did birth control cost before the ACA?

Birth control use is nearly universal among women of reproductive age in the United States and is a key part of preventive healthcare for women. Therefore, it’s surprising that the financial burden of birth control costs before the mandate was so astounding. To put it into perspective, IUDs cost over $1,000 in most states and the pill cost around $20-$50 per package. In addition to their monthly premiums and yearly deductibles paid for health insurance, women also had to cover these out-of-pocket costs for birth control. This financial burden made access to birth control that much more difficult. Luckily, the mandate helped lift this barrier.

A 2015, Health Affairs study showed that out-of-pocket spending on the pill has decreased by nearly 50%, saving women an estimated $1.4 billion per year on birth control medication, since the Affordable Care Act was signed into law.

Is birth control free under the ACA?

Before the birth control mandate came into effect, women were required to pay out-of-pocket costs for birth control alongside their monthly premium and yearly deductible for their healthcare plans. Now you no longer have to pay those out-of-pocket costs. The ACA requires insurance companies to cover contraceptive methods and counseling even if you haven’t met your deductible.

By requiring coverage for contraceptives with no out-of-pocket costs, the ACA increased women’s access to a wide range of contraceptives. However, you should know that insurance companies can charge you a copay, or deductible if you require a brand-name drug — but typically there is a generic version available.

Are all types of birth control covered?

Virtually all conventional methods of birth control are covered by the ACA. All Food and Drug Administration-approved contraceptive methods prescribed by a woman’s doctor are covered, including:

  1. Barrier methods, like diaphragms and sponges
  2. Hormonal methods, like birth control pills and vaginal rings
  3. Implanted devices, like intrauterine devices (IUDs)
  4. Emergency contraception, like Plan B and Ella
  5. Sterilization procedures
  6. Patient education and counseling

If you require a follow-up visit to manage or discuss side effects of your birth control, or to have an IUD removed, for example, your plan should also cover this visit at no out-of-pocket cost to you.

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.

Can I get free birth control without insurance?

The cost of birth control without insurance is quite expensive. But getting birth control without health insurance isn’t impossible and sometimes you can even find it for free.

One of the key components of the ACA was the loosening of eligibility requirements for Medicaid family planning services. Because Medicaid provides full coverage of family planning services, increasing access to Medicaid also expands access to contraception.

However, each state is different in terms of what services the plan offers. In general, a variety of birth control methods like intrauterine devices (IUD), diaphragms, or getting your tubes tied are available. But, over-the-counter methods like oral contraceptives and the sponge are covered less often.

If you don’t qualify for Medicaid, you can access free women’s health services which often includes birth control at public health centers. From organizations like Planned Parenthood to smaller, free birth control clinics that may offer such assistance. A lot of Planned Parenthood health centers offer a variety of birth control methods for free or at a low cost. Some even offer payment plans or sliding scale payments depending on your income.

You can also call your local health department to find out about your options for getting free birth control. Some of the clinics associated with your local health department will offer you birth control at a reduced price or help you apply for programs that allow you to access it for free.

So how does the birth control mandate affect you?

Every year in the United States, 600 to 700 women die because of complications associated with pregnancy, and the maternal mortality ratio in the United States remains on a steady rise. Reducing unintended pregnancy is an important element of addressing the unacceptably high maternal mortality ratio in the United States.

The financial benefits of free birth control for women are obvious. In 2013, just a year after the mandate took effect, women saved nearly $500 million on out-of-pocket-costs for birth control. Thanks to the mandate, many women no longer have to choose between paying for birth control and paying for other necessities, like groceries and utilities.

Access to birth control also provides health benefits for women and children, and improves women’s ability to control whether and when they have a child. The ability to plan pregnancies allows women the time and finances to invest in their own education and careers and participate more fully in the workforce, benefitting not only themselves and their families but also the society as a whole.


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