UPDATE: 2019 open enrollment for the Affordable Care Act plans runs from November 1, 2018 to December 15, 2018. Find out more here.
On May 11th, 2015, the government released an FAQ list explaining exactly what insurance plans should cover in terms of preventive services, including birth control. Fingers crossed that this clarification will resolve some of the issues with birth control coverage we’ve heard about.
Some insurers are doing it wrong
Hopefully you’ve heard us shouting from the rooftops that insurance companies have to cover birth control without out-of-pocket costs. It’s the law, thanks to the Affordable Care Act (ACA, a.k.a. ObamaCare). It’s true that there are exceptions for grandfathered plans and some types of employers, but by now the law should apply to the majority of health insurance plans.
So if you’re still getting charged for your birth control or birth-control-related services, it may be because your insurance company is bending the rules. Several recent studies have found that some insurance companies aren’t covering everything the law says they should. The studies found a few persistent problems:
1) Insurers aren’t covering all FDA-approved birth control methods. Eg. The pill is covered, but not the ring or the patch.
2) Insurers are covering the birth control but not all the related services. Eg. The IUD is covered but not the appointment to get it inserted.
3) Insurers are charging copays or deductibles for birth control. Eg. Your birth control is covered but you have to pay a $30 copay to get it.
The real deal
Insurers do have a little flexibility. Plans aren’t required to cover all brands of birth control, so for example it’s legal to cover some types of the pill but not others. The law says plans have to cover all 18 FDA-approved birth control methods for women, even if there’s no generic version. (That includes the ring, IUDs, and the implant.) What if your plan doesn’t cover the birth control you use? There should be a way for you to get it covered if your health care provider notifies your insurer that your birth control of choice is medically necessary.
The government confirmed that health insurance plans need to get with the program by releasing an FAQ list that makes the rules about birth control coverage even clearer. Any insurance plans issued or renewed starting in mid-July should provide coverage as specified by these new FAQs. If you’re in the middle of your plan year, you might not see a change until your plan renews.
What can I do if my plan charges me for birth control?
Call in the experts! The National Women’s Law Center runs the CoverHer hotline just for cases like this—you can reach them at 1-866-745-5487. They will help you navigate the process of getting accurate information from your health insurance plan, and if you need to make an appeal, they can help with that, too. If you’re willing to put up a fight, you can probably get the coverage that your plan owes you.