You might have heard that birth control may be free as part of health care reform. Is your type covered? What about condoms? Are there any exceptions?
Here are answers to those and other common questions about birth control coverage as part of health care reform.
Will my birth control be free under the Affordable Care Act?
You will not have a copay or other out-of-pocket costs for birth control, if you:
- Get your health insurance through most employers, through your state's Marketplace, or from most private insurers, and
- Have a doctor’s prescription for any type of birth control approved by the FDA. This includes the ones usually sold over the counter like spermicides and sponges.
Does every health insurance plan have to pay for birth control?
- These terms of the Affordable Care Act apply only to new health insurance plans offered from your employer or that you buy on your own. Certain religious employers are exempt and do not have to include birth control benefits.
- Medicaid programs do not have to offer free birth control either, but most state Medicaid programs do cover prescription birth control methods.
Which types of birth control are free?
Birth control methods that are covered by this requirement of the Affordable Care Act include any that are approved by the FDA:
- Birth control patch
- Birth control pills
- Birth control ring (NuvaRing)
- Birth control shot (Depo-Provera)
- Cervical cap
- Contraceptive implant
- Permanent contraception methods, such as tubal ligation, often called "getting your tubes tied"
- Emergency contraception (Plan B, Ella, and Next Choice)
Your plan may also cover over-the-counter birth control, but you will need a prescription from your doctor if you want it to be covered without out-of-pockets costs.
Will my doctor exam also be free if I get a prescription for birth control at that appointment?
Often, yes. Your well-woman visits are covered with no out-of-pocket costs to you under the Affordable Care Act. During this visit, your doctor can tell you about the types of birth control and write you a prescription. However, if you get the prescription during a visit when you also get other services that don’t qualify for coverage with no out-of-pocket costs, you have to pay out-of-pocket costs for the visit.
Will my insurance cover the cost of over-the-counter female birth control methods?
Only if you have a prescription from your doctor. Over-the-counter birth control for women includes sponges, the female condom, and spermicides.
You'll still be able to buy them without a prescription, but you’ll have to pay for them on your own.
Where do I need to buy my birth control for it to be covered?
You don't have to change how or where you get it. You can get your birth control where you usually buy it: at your local pharmacy with a doctor's prescription, or through a mail order or online pharmacy. Your insurance company may, however, require you to go to an in-network provider or pharmacy.