What does the Affordable Care Act say about birth control coverage? Does your insurance cover your birth control method? What about condoms? Are there any exceptions?
Here are answers to those and other common questions about birth control coverage.
Is birth control free under the Affordable Care Act?
Under ACA, you don’t 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?
The birth control terms of the Affordable Care Act apply to most health insurance plans, but there are some exceptions:
- Plans that didn’t offer coverage for birth control before ACA and that haven’t changed significantly since the law passed in 2010 don’t have to add coverage. Check with your plan to find out if this applies to you.
- Short-term health plans, those that provide insurance for less than 12 months, do not have to provide free birth control.
- Private employers that object to offering birth control on moral or religious grounds and can get an exemption from the federal government don’t have to provide coverage. In some cases, their insurer may still provide birth control benefits without a copay or other charges, but this accommodation is optional.
- Medicaid programs already offered free birth control prior to the ACA, 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:
- Birth control patch
- Birth control pills
- Birth control ring (Annovera, 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-pocket 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 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 may not 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.
Do ACA requirements 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
Can I get brand-name birth control pills?
Generally, yes, though you must confirm that with your health plan. However, you may have to pay cost sharing for brand-name birth control.
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. In addition, some states require plans to cover vasectomies.
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 mifepristone (Mifeprex), a pill that induces abortions.
Who is covered under Medicaid expansion?
The Affordable Care Act allows states to expand their Medicaid programs to cover individuals and families with incomes up to 138% of the federal poverty level. With this expansion, many more women are 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.