Health Insurance and Birth Control or Contraceptives
Women (and men) who want or need to use birth control have a ton of options these days. But do U.S. health plans usually cover those contraceptives? You’ll find answers to that question and many others in this article.
Why does it matter if health insurance covers birth control or not? Or why should anyone care if health insurance covers birth control or not?
Those questions can be answered in a number of ways.
For example, one possible reply is that birth control--or contraceptives, or even “family planning,” if that’s what you prefer--is expensive. Or it can be, especially if your insurance plan doesn’t pay for it.
On the low end, there’s what most people know as “the pill.” Without health insurance, you’ll pay about $50 per month for these oral contraceptives. (Although this isn’t the extent of what you’ll pay if you go on the pill, as the saying goes. That’s because doing so requires a prescription. And seeing a doctor or physician to get that prescription can cost as much as $250 if you’re uninsured.) With insurance, you may pay nothing out of pocket for it.
On the high end, there’s “getting your tubes tied”--a procedure otherwise known as tubal ligation or female sterilization. If you don’t have health insurance, you could pay as much as $6,000 to have this done. And if you do have insurance? Again, you might pay nothing for it.
Those figures alone make it clear why so many Americans care whether or not their health insurance plans cover birth control.
How many Americans are we talking about here? According to the Kaiser Family Foundation, nearly all women have used contraceptives at some point in their lives, so it’s probably safe to say the vast majority of them consider insurance coverage of them to be important. The same could be said of the 62 percent of U.S. women currently using at least one method of birth control.
Speaking of which, you’re likely wondering: how many of those birth-control methods do U.S. health insurance plans usually cover? Or how do specific types of health insurance plans--from those offered by employers to those bought through the government-run “marketplace”--tend to cover contraceptives?
Keep reading for answers to those questions and many more.
Do job-based or employer-sponsored health insurance plans usually cover birth control?
If you get health insurance from your employer, it’ll likely help you or a covered family member pay for at least some forms of birth control.
After all, back in late 2016, the same Kaiser Family Foundation mentioned earlier reported that more than four-fifths (85 percent) of large firms cover prescription contraceptives in their largest health plans.
That statistic doesn’t tell you how many kinds of birth control those job-based plans cover, of course. For that, you have to look at your specific policy. Or you need to talk with your employer--or with the company that provides its health insurance.
That statistic also doesn’t tell you how the health insurance plans small and medium firms offer to their employees cover (or don’t cover, as the case may be) contraceptives.
So what if you work for a small- or medium-sized company? Don’t worry, you should have access to health insurance that covers birth control to some extent. Why? The Affordable Care Act, also called the ACA or Obamacare, requires most private health insurance plans to cover a broad range of preventive services, including FDA-approved contraceptives, with no out-of-pocket costs on the part of the policyholder. (That last bit means neither your insurer nor your plan can charge you copayments or coinsurance for these services or products. And this is true even if you’ve yet to meet your plan’s deductible.)
Still, there are exceptions. For instance, certain religious employers don’t have to cover contraceptive methods and counseling. Some religious non-profits are in the same boat. If you work for one of these organizations, you may have to pay for birth control out of your own pocket.
Does the Affordable Care Act require health insurance plans to cover birth control or contraceptives? Or what does the Affordable Care Act say about birth control or contraceptive coverage?
Yes, the Affordable Care Act, passed into law in 2010, requires most health insurance plans sold or offered to Americans to cover a number of birth control options.
Before the ACA’s passage, this kind of contraceptive coverage was widespread, but it also was far from universal.
Although it’s still not universal thanks to the religious and moral objections the law allows some employers to make, it’s closer to that point than ever before.
So what does the ACA specifically say about U.S. health insurance plans and birth control coverage? The main bullet point worth highlighting here is it requires most plans to cover FDA-approved prescription contraceptives for women.
Similarly important, though, is the requirement that impacted plans not charge copays or coinsurance for these products and services. That’s a big deal because the copays or coinsurance fees tied to a procedure like tubal ligation can be expensive.
There are a few “catches” to this coverage, though. One is that in-network physicians or providers have to prescribe or administer these contraceptives or services. Another is that the ACA allows insurers and plans to use certain “medical management” tactics to control costs, including:
- Placing brand-name and generic birth control drugs and devices in different tiers based on their cost or type.
- Requiring policyholders to try a lower-tier drug or therapy before they (the insurance company) will cover a higher-tier drug or therapy.
- Steering enrollees and their dependents toward generic drug options.
Also, some organizations with religious affiliations and objections are exempt from this “mandate” and so don’t have to include birth control coverage in the health plans they offer employees.
At the moment, only certain religious employers can take advantage of these exemptions. That may soon change, though, thanks to the efforts of President Trump and his administration. Late last year, the administration released a pair of rules that aimed to expand those exemptions and allow almost any company or organization to drop birth control coverage from the health plans they offer employees due to religious or moral objections.
Federal judges have since blocked the rollout of those policies, but the Justice Department could still appeal the rulings.
Do Obamacare marketplace plans cover contraceptives?
All health insurance plans sold through the “marketplace” created by the Affordable Care Act have to cover contraceptive counseling. And they have to cover a number of different contraceptive methods, too. (As long as an in-network doctor or physician prescribes them, naturally.)
Some of the many contraceptives marketplace plans must cover:
- birth control pills
- IUDs and other implanted devices
- vaginal rings
ACA marketplace plans also have to cover emergency contraception--also known as “the morning after pill”--and various sterilization procedures for women.
They don’t have to cover drugs that induce abortions or male birth control options, such as vasectomies and even condoms. (For more information on how U.S. health insurance policies tend to treat abortion, by the way, read our article on the subject, “Health Insurance and Abortion Coverage: Do Health Plans Pay for Abortion?”)
If you can’t tell if your marketplace health plan covers the contraceptives you need or want to use, look through its documentation. Or pick up the phone and call the insurance company that provides your coverage. Someone there will be able to set you straight.
Do off-marketplace health insurance plans cover contraceptives or birth control?
Most off-marketplace plans cover a wide range of birth control methods and services.
If you’re not sure what off-marketplace plans are, by the way, they’re health plans bought directly from insurance companies, as opposed to bought using the ACA or Obamacare marketplace.
As is true of almost everything related to health insurance, however, there are exceptions. Not all off-marketplace plans cover all forms of birth control.
So, if you want your health plan to pay for (or to help pay for) the contraceptives you use, carefully review the policies that most appeal to you before enrolling in one. And don’t be shy about asking the insurers selling those plans for more information if their documentation isn’t clear.
Could you use some help choosing a policy? Check out our article on the topic, “How to Pick a Health Insurance Plan.”
Does short-term health insurance cover birth control or contraceptives?
It’s hard to say, unfortunately.
Why? For starters, the Affordable Care Act doesn’t cover these plans, which also are known as temporary health insurance plans or term health insurance plans.
That’s a bummer for a few reasons, with a big one being that it means short-term health plans don’t have to cover any birth control methods or services if they don’t want to do so.
Is it possible, even likely, some short-term health insurance policies cover contraceptives anyway? Definitely. Once again, though, you’ll really have to do your homework to find the ones that do.
Another potential issue related to the ACA’s lack of influence or impact on short-term health policies and how they do or don’t cover birth control: no regulations limit how much insurers charge for these plans or how much they spend on care.
In other words, you may find some short-term health insurance policies that will pay for the contraceptives you use, but you’ll have to pay an arm and a leg for that coverage.
If you want a short-term health plan that covers birth control, thoroughly research any and all that appeal to you before you sign on the dotted line. And pick up the phone and call the insurance companies selling them if the information you find on line (or elsewhere) isn’t clear.
Want to learn more about these policies? Read our article on short-term health insurance.
Does Medicaid cover birth control or contraceptives?
First, the short answer. Or the “good news,” if that’s how you’d prefer to put it. Regardless, Medicaid covers various aspects of family planning--from counseling, to screening services, to contraceptives.
Now, the longer answer. Or the “bad news,” if you will. Due to the complicated way in which Medicaid is set up and administered, it’s hard to say which forms of birth control your state’s program will or won’t cover.
There are a number of reasons for that, including:
- Although the federal law says family planning services are mandatory Medicaid benefits (and that they must be provided to all enrollees of childbearing age), the law doesn’t define “family planning.” Because of that, states basically decide for themselves which birth control methods and services they cover and which ones they don’t.
- Also, though the ACA requires Medicaid to cover contraceptives in a way that’s similar to how marketplace health insurance plans cover them, that requirement doesn’t apply to “traditional” Medicaid that was available before the ACA was signed into law.
- Finally, states can set different coverage requirements for Medicaid-funded family planning services for different eligibility pathways. (Traditional Medicaid that was available before Obamacare is one example of an eligibility pathway. ACA Medicaid expansion is another.)
Given all of the above, the only way to find out which forms of birth control your state’s Medicaid program does and doesn’t pay for is to contact your local agency and ask about it.
How do I know if my health insurance plan covers birth control? Or how can I tell which forms of birth control my health plan covers or doesn’t cover?
The quickest and easiest way to tell if your health insurance covers a certain kind of contraceptive or birth control is to look at your policy.
Admittedly, that’s often easier said than done. After all, insurance plans aren’t known for being understandable or accessible.
Thankfully, you don’t have to stop there. If your policy doesn’t make it clear which types of birth control it covers or doesn’t cover, contact the insurance company. A quick email exchange or phone conversation should be enough to bring you up to speed in this area.
Another option: if you get health insurance through your employer, ask your human resources manager to provide some clarity here.
And if Medicaid provides your health coverage, talk with someone at your local agency.
Basically, the best thing you can do in this kind of situation is to not be shy about asking for help if you can’t figure out whether or not your health insurance plan covers birth control or which forms of birth control it covers.
If a health insurance plan covers one of type of birth control, does it usually cover all of them, or many of them?
It depends. If you buy a health insurance plan from the ACA marketplace, it is required by law to cover a wide range of birth control methods and services. The same is true if you buy a health insurance plan directly from an insurance company.
Most U.S. companies and organizations offer their employees health coverage that pays for at least some contraceptives, but there are many exceptions. Also, how one employer’s plans cover birth control is sure to differ from how another employer’s plans cover it just because that’s how these things work.
All that said, it’s probably safe to say that if a health insurance plan covers at least one form of birth control, it’ll likely cover others as well. How many others, though, will depend on the company providing that coverage.
What can I do if my health insurance plan doesn’t cover contraceptives?
If your health insurance plan doesn’t cover contraceptives, or won’t pay for the birth control methods you use, you can:
- pay for them out of your own pocket
- see if you qualify for Medicaid or other state programs that could help you pay for them
- contact Planned Parenthood
Most of what has been discussed here so far concerns birth control for women. Does health insurance cover men’s contraceptive methods, too?
Although federal and state laws do a good job of forcing most health insurance plans to cover birth control for women, the same can’t be said of how they treat male contraceptives.
In fact, there’s basically nothing that requires U.S. health insurance plans to help people pay for vasectomies or condoms.
That doesn’t mean it’s impossible to find a health policy that offers coverage for those procedures and products. You may have to do some real digging before you come across one, though.
What are my options when it comes to birth control?
Women who don’t want to become pregnant accidentally have a slew of options these days when it comes to choosing between contraceptives. Here are the most common methods:
- birth control pill, patch, or shot
- cervical cap
- condoms (both female and male)
- IUDs and other implanted devices
- sterilization procedures like tubal ligation (for women) and vasectomy (for men)
- vaginal rings
According to the Kaiser Family Foundation, “the pill” is the most commonly used form of birth control among U.S. women. Female sterilization (tubal ligation) and male condoms follow just behind it in popularity. IUDs and other kinds of implantable contraceptives are becoming increasingly popular, too.
To learn more about each of the birth control methods listed above, visit plannedparenthood.org.
How much do contraceptives cost with health insurance? How much do contraceptives cost without health insurance?
This is a difficult question to answer, and for a couple of different reasons. One reason is there are a lot of contraceptives on the market today. Another reason is insurance companies and plans cover birth control in different ways and to different extents.
That said, it’s possible to give you a general idea about how much some of these drugs, devices, and procedures cost with and without health insurance.
According to various sources, for instance, birth control pills cost about $50 a month if you don’t have insurance (or you don’t have insurance that covers such things). With insurance, it may well cost nothing.
You might have to pay anywhere from $200 to more than $1,000 for the various kinds of implantable contraceptives without health insurance coverage. With it, again, you may pay nothing.
How about the various sterilization procedures that have been discussed in this article? Males may pay just $1,000 or so for it without the benefit of health insurance, while females could pay many times that amount (or as much as $6,000). What do you think they pay if they have a health plan that covers this form of birth control? You guessed it: zero!
As you’ve probably already gathered, when a health insurance plan covers birth control, it tends to cover it well. But when you lack that sort of protection, you could pay a little or a lot for your needed (or wanted) contraceptives.
Why should I care if health insurance covers birth control or not?
Beyond the fact that a lot of women--and men--rely on birth control to avoid becoming pregnant and that contraceptives can cost a lot of money if you have to pay for them out of your own pocket, there’s also this: many women turn to it for help with menstruation, endometriosis, acne, and more.
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