Birth Control Coverage: FAQ

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 health insurance plans that are not considered “grandfathered” (you can check with your plan to find out). This means they have not changed significantly since the health care law was passed in 2010.
  • Certain religious employers are exempt from the requirement to provide birth control.
  • Some private employers object to offering birth control on religious grounds and may get an accommodation from the federal government. But in such cases their insurer must still provide birth control benefits without a copay or other charges.
  • Medicaid programs already offered free birth control prior to the health reform law, although they are not required to cover all FDA-approved birth control methods. Check with your Medicaid office to find out what types of birth control are offered. In addition, states are given the option to provide family planning services only for low-income individuals who would not otherwise be eligible for Medicaid. Just over half the states have expanded family planning services under this option.

 

 

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:

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-pocket costs.

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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 available to you and write you a prescription. However, if during the visit the doctor diagnoses or treats you for another medical condition you will likely 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.

Does the plan cover any other types of birth control services?

Yes. You also can get contraceptive counseling from your doctor at your well-woman visit at no additional charge. That includes information on:

  • The types of birth control that are available
  • How these methods work to prevent a pregnancy
  • Which type of birth control might be best for you

When does this new coverage start?

Most health insurance plans now cover birth control. Plans that existed before the health reform law may have “grandfathered” status and may not have to offer this coverage. Check your policy or call your insurance company for information about your coverage.

Can I get brand-name birth control pills?

Generally, yes, though you must confirm that with your health plan. However, you will pay more for brand-name birth control than for generic.

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Is birth control covered for men in health insurance plans?

No. Only women's birth control is covered. Health insurance companies do not have to pay for male birth control, such as condoms and vasectomies. In some states, Medicaid provides family planning services and supplies to eligible men and women under the state plan. Contact your local state Medicaid agency to see if you qualify for coverage for family planning services.

Are "morning-after" pills covered?

Emergency contraceptives, such as Plan B One-Step, Next Choice, and Ella, are covered when prescribed by a health care provider.

Do health insurance plans have to pay for "abortion pills"?

No. Health insurance plans are not required to pay for Mifeprex (mifepristone), a pill that induces abortions.

Who is now covered under Medicaid expansion?

The Affordable Care Act creates new opportunities for states to expand their Medicaid programs to cover individuals and families with incomes up to 138 percent of the federal poverty level (about $16,400 for an individual in 2016). With this expansion, many more women may be eligible to get their birth control paid for by Medicaid. Go to Healthcare.gov's Medicaid expansion information to see if your state has expanded coverage. Also, some states have chosen a separate option created to provide family planning services and supplies to certain individuals; you can contact your state Medicaid agency to find out if you are eligible for coverage under this option. 

WebMD Medical Reference Reviewed by Sarah Goodell on September 08, 2016

Sources

SOURCES:

The American Congress of Obstetricians and Gynecologists, "Committee Opinion: Benefits to Women of Medicaid Expansion Through the Affordable Care Act," January 2013.

Healthcare.gov: "Is my state expanding Medicaid coverage?"

Medicaid.gov: "Eligibility."

HHS.gov: “Administration takes steps to ensure women’s continue access to contraception coverage, while respecting religious-based objections.”

 

 

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