Will Insurance Pay for Birth Control?
Before the Affordable Care Act (ACA), health insurance plans were not required to cover any forms of birth control. After Congress passed the ACA in 2010, insurance companies were required to cover all FDA approved forms of birth control in their plans with no co-pay, no-deductible aka “free.” 62.8 million women have birth control insurance coverage with no out-of-pocket costs thanks to the ACA. This is 7 million more than in 2015!
US Women now have access to at least 1 in each of 18 categories “free” contraceptives through their insurance plans. But it’s important to know which types of birth control are covered under the Affordable Care Act and which contraceptive products are not. (TLDR: all the FDA approved methods should be covered, just not specific brands if a generic is available. Watch this video on brand vs generic birth control.)
Which birth control products are covered under the ACA?
Currently, there are 18 FDA-approved categories of birth control. Under the ACA, insurance companies are required by law to cover at least one contraceptive method from each of these categories.
What are the different types of FDA-approved contraceptive categories?
- Hormonal birth control methods – the pill, patch, ring, or shot.
- Barrier methods – diaphragm, spermicides, female condoms, and sponges.
- Prescription Emergency Contraception = Ella® (ulipristal acetate)
- Over the Counter Emergency contraceptives such as Plan B® (levonorgestrel) and its generics
- Implant (Nexplanon®)
- Intrauterine devices – hormonal and nonhormonal IUDs.
- Sterilization for women
- Patient counseling and education.
Insurance plans can significantly vary from company to company. It’s critical that women understand that a particular insurance company is not required to cover every brand of birth control. An insurer can choose to include a generic birth control pill, instead of a name-brand pill and they would still be operating within the ACA mandates. Insurers can also charge co-pays for name-brand pills. However, if there is no generic form of a particular birth control method and it is necessary for the patient to have it, then the insurer is required to pay for it. The ring is a prime example of this because there is no generic form of the birth control Nuvaring®.
It’s also important to note that under the ACA, insurers are not required to cover any abortifacient drugs, or male condoms or vasectomies.
How much do some of the most popular birth control methods cost?
Birth control costs will vary based on the method, whether or not it is a generic form, and if a woman has to pay part of the cost or full cost. For reference, couples in the U.S. who are considered middle-income pay about $12,500 per year for one child.
Although there are free birth control methods that do not require money or insurance, such as fertility awareness methods or the withdrawal method, they do not have as high of an effectiveness rate (77%-88%) as hormonal birth control methods. The birth control pill has an effectiveness rate from 93% (typical use) to 99.7% with perfect use. The IUD has an effectiveness rate of 99.9% (typical use), but it does have a much higher upfront cost (if you don’t have insurance) than patches, rings, pills, or condoms.
- The birth control pill – cost varies based on generic or name-brand versions, but the average price is $15 to $50 per month. Birth control pills can cost on average between $180 to $600 per year.
- The birth control ring and patch cost about $1800 per year or $150/month.
- The average couple will spend $150 per year on condoms.
- The average yearly cost of a cervical cap, including spermicide, is between $35 and $60 per year.
- IUDs cost between $500 and $1000, but the Copper IUD can last for up to 12 years and the IUD with hormone (depending which one) can last 7 years. Using an IUD actually costs less per year than condoms for the average couple.
- The cost of the birth control shot averages between $220 and $460 per year.
- Male sterilization can cost between $350 and $1000,
- Female sterilization can cost between $1500 and $6000.
How can women who work for religious institutions pay for birth control?
Not every insurer is required to follow the ACA birth control coverage mandates. Religious institutions, non-profit religious organizations, and religious schools are also exempt from covering birth control. For women whose insurance is through a religious employer, they will have to pay for their birth control out-of-pocket. It is possible though for women to use a third-party insurer to cover the cost of birth control fully.
Which health insurance plans aren’t required to cover birth control?
- Plans offered by religious or non-profit religious organizations, but women are given contraceptive coverage through a third party. However, churches and houses of worship do not have to provide direct or third-party coverage.
- Plans that were purchased before March 23, 2010 (grandfathered plans).
- Short-term health insurance plans.
- Alternative plans that exclude some forms of controversial birth control. For example, health-sharing ministries can kick a person off of their plan if the person tries to obtain birth control.
What can uninsured women do to get low-cost or fully covered birth control?
Women who are unemployed, or who make below a certain annual yearly income may be eligible for Medicaid. Medicaid eligibility requirements vary per state. Before the ACA, Medicaid programs were required to cover specific, but not all forms of birth control. Most Planned Parenthood clinics will accept Medicaid insurance plans for birth control and always have a sliding scale. Pandia Health established the Pandia Health Birth Control Fund to cover birth control medications and annual online doctors visits for those with financial need.
For women who are uninsured, insured through an employer, and are not eligible for Medicaid, they can still find free, or low-cost birth control. Planned Parenthood offers free and low-cost birth control for women who qualify, and certain healthcare providers may provide inexpensive birth control.
How can a woman find out if her insurance covers birth control?
It’s important that women contact their health insurance provider to find out exactly what types of birth control their plan will cover. They will also need to find out if they will have to pay a co-pay for a particular kind/name/brand of birth control.
Are you interested in obtaining free (if you have insurance) to low-cost birth control pills, the patch, or the ring? The representatives at Pandia Health are standing by to answer your questions about insurance coverage. Please contact Pandia Health today about having prescription birth control conveniently delivered to your home.