UPDATE: 2021 open enrollment for the Affordable Care Act plans runs from November 1, 2020 to December 15, 2020. You can enroll at healthcare.gov. Some states have their own open enrollment periods and websites for signing up. Check to see if your state does. We also have more information about how to get insurance and learn what kinds of plans to watch out for.
You know how we’ve been telling you that birth control should be completely covered by health insurance under the Affordable Care Act (ACA)? That means no copays, no coinsurance, and no deductibles. It also means that if you find yourself paying any money out-of-pocket to pick up your birth control refill, you may be getting charged illegally.
In September, Congresswoman Jackie Speier wrote to the CEOs of CVS and Walgreens asking about reports from women—including a member of her own staff—who said they’d been charged copays for generic prescription birth control. (BTW, if you use brand name birth control that has a generic equivalent, your copay situation may be different—here’s more information about that.) CVS responded to Congresswoman Speier saying that the charges were due to a coding error that should now be fixed. They’ve promised to reimburse the 11,000 customers they say have been charged illegally.
So what does this mean for you?
Hopefully CVS, Walgreens, and other pharmacies will get any issues resolved and you’ll never have to deal with being charged an illegal copay for your birth control. But if you do, here are three tips that should help make sure you get your birth control covered.
1. Ask about the charge.
The easiest way to deal with an illegal copay is to nip it in the bud immediately. So if you’re checking out at the pharmacy and your receipt says something other than $0, ask the pharmacist about the charge. If the pharmacist tells you to call your insurance company, don’t be put off—ask to call together. The pharmacist or someone on staff should be willing to call your insurance company with you and resolve the issue on the spot.
2. Follow up within seven days.
If for whatever reason you can’t resolve the issue while you’re physically at the pharmacy, or if you don’t realize you’ve been charged until after you’ve left, follow up with the pharmacy as soon as possible. Target, Walgreens, and CVS all have policies that make it easier to reverse pharmacy charges through the pharmacy itself within 7 days of payment. If you miss the 7-day window from when you paid for your prescription, you’ll have to go through your health insurance to get a reimbursement.
3. Don’t give up.
If you miss the 7-day window, getting reimbursed for an illegal copay might be slightly more complicated, but it should still be possible. Call your insurance company to find out your options.
If you have questions for CVS about a copay charge (or if you think you should be receiving a reimbursement and want to confirm), CVS recommends calling 1-800-704-6589 and asking to speak with a Tier 2 representative or supervisor to make sure you get someone who can help on the line. If you think you’ve been illegally charged for your birth control by the pharmacy or your insurance company and you’re having trouble getting answers or reimbursement, you don’t have to deal with it alone. Reach out to CoverHer.org, a hotline run by the National Women’s Law Center, at 1-866-745-5487—or email them at CoverHer@nwlc.org—for help.