Does insurance cover birth control?
(NerdWallet) – Most health insurance plans cover birth control without requiring you to pay anything out of pocket. Some employers are exempt, and federal law makes exceptions that allow health plans to cover limited forms of birth control. But there are ways to appeal to your insurance company if you’re forced to pay for birth control prescribed by your doctor.
Is birth control free?
If you have health insurance, specified types of birth control should be free to you because your plan is required to cover the full cost.
Birth control is a type of preventive care. Under the Affordable Care Act of 2010, most health insurance plans must cover the total cost of preventive care, meaning they don’t charge you coinsurance or a copayment. Besides contraceptives, preventive care that’s fully covered by insurance under the ACA includes annual wellness checkups, disease screenings and immunizations.
The ACA’s requirements apply to birth control methods approved by the U.S. Food and Drug Administration and prescribed to women (so procedures like vasectomies aren’t included). Insurers must cover at least one form of each birth control method without charging out-of-pocket fees to patients.
FDA-approved birth control methods fall into six groups:
- Patient education and counseling.
- Hormonal methods, including birth control pills and vaginal rings.
- Implanted devices, such as intrauterine devices, or IUDs.
- Barrier methods, including diaphragms and sponges.
- Sterilization procedures.
- Emergency contraception.
When your insurance doesn’t cover birth control
Even if you’re insured, a number of exceptions in the ACA may prevent you from getting birth control for free. Here are the factors:
- Who sponsors your health plan. Employers can be exempt from covering contraceptives for employees if they have religious or moral objections.
- When your health plan was established. “Grandfathered” plans — or those that predate the ACA and remain basically unchanged — don’t have to follow all the federal regulations. Employer health plans typically change from year to year, which would mean they’ve lost grandfather status.
- Where you get medical care. Insurance likely requires you to access preventive care through an in-network provider to have it fully covered.
- How your insurance company manages care. The ACA allows insurers to set reasonable rules around the medical care they’ll cover so companies can control costs and encourage efficiency.
In practice, medical management tactics can steer you toward generic drugs and devices by making you pay out of pocket for brand-name options or jump through hoops to get your contraceptive of choice covered. If your prescribed form of birth control isn’t fully covered, you should talk to your doctor and go through your insurer’s waiver process.
Getting birth control without insurance
If you don’t have health insurance or your insurance doesn’t cover birth control, there are other options for obtaining contraceptives for little or no cost.
People earning low incomes who qualify for Medicaid can get free family planning services. In most states, those services include birth control, according to the Kaiser Family Foundation.
Some health clinics provide family planning and preventive health services at little or no cost. These Title X clinics receive federal funding through the U.S. Department of Health and Human Services’ Title X Family Planning program.
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