Men’s health and the Affordable Care Act: What’s covered?
Here’s what’s covered (and what’s not) under the Affordable Care Act when it comes to men’s sexual health.
UPDATE: President Biden has opened a special enrollment period for the Affordable Care Act health insurance plans for 2021. You can now enroll in one of these plans until August 15, 2021, 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.
We talk a lot about the awesome things that the Affordable Care Act (ACA, a.k.a. ObamaCare) has done for women’s health, including (but definitely not limited to) birth control coverage without out-of-pocket costs. The ACA also covers a lot of preventive services related to sexual health beyond birth control. Preventive care is important for men, too—so what’s covered for them?
What’s covered for men?
The good news is that for adult men (and women), there’s a long list of preventive services that insurance companies are required to cover without out-of-pocket expenses. Covered services related to sexual health include:
Hepatitis B screening for adults at high risk
Hepatitis C screening for adults at high risk
HIV screening for everyone ages 15 to 65, and other ages at high risk
Immunization vaccines for adults (doses, recommended ages, and recommended populations vary) including: hepatitis B, HPV, flu shot, and meningococcal vaccines.
Sexually Transmitted Infection (STI) prevention counseling for adults at high risk
Syphilis screening for adults at high risk
In addition, transgender men can access preventive services based on medical need rather than gender identity. For example, a transgender man who hasn’t had gender transition surgery or has residual breast tissue may need a mammogram. That should be covered under the ACA.
What about birth control?
Unfortunately, despite a constant stream of media claiming it’s just around the corner, the U.S. is still a long way from having a hormonal birth control option for men on the market. So while we continue to keep our fingers crossed for more options down the line, in the meantime, there are three birth control options guys in the U.S. can use: condoms, vasectomy, and withdrawal, a.k.a. the pull-out method.
Unfortunately, condoms and vasectomies are not covered by the Affordable Care Act’s guarantee for contraceptive coverage without out-of-pocket costs. This might not seem like a big deal, until you realize that almost 1 in 4 women (23%) rely on their partners’ vasectomies or use of condoms as their main way to prevent pregnancy.
Condoms are extremely popular (probably because they help prevent both pregnancy and STIs). In fact, condoms are the third most popular contraceptive method for women in the U.S. The good news is condoms are often cheap and easy to find, even without insurance coverage. Many health clinics provide them for free. The Condom Finder network can help you find free condoms near you.
While there are lots of ways to get free condoms, there are also lots of different kinds of condoms, so if you can afford to buy them, it may be worth shopping around for a size, fit, and feel you and your partner both enjoy. Condoms are sold in many convenient places—grocery stores, drug stores, and even in gas stations—or you can order them online.
A vasectomy (a.k.a. male sterilization) is a permanent birth control option that prevents sperm from mixing with semen. (No sperm = no pregnancy.) That means a guy who had a vasectomy can still orgasm and ejaculate, but without the sperm. Female sterilization (a.k.a. getting your tubes tied) is more common in the U.S., but vasectomies are actually quicker, simpler, and safer. Sterilization is one of the most effective birth control methods, up there with the implant and the IUD. Without insurance coverage, vasectomy is also about 1/3 the cost of tubal ligation.
Vasectomies are on the rise in the U.S., and the proportion of men who’ve had one increases with age. About 7% of all men ages 15-44 have had a vasectomy, but looking only at men ages 35-44, the proportion rises to 16%. A study of men who had a vasectomy found that the most common reasons for choosing vasectomy were because it is effective at preventing pregnancy, safe, and lets men actively participate in family planning.
Private insurance companies may cover all or some of the costs for a vasectomy—but if cost could be a deal-breaker, contact your insurance provider to see how much they cover before booking an appointment. Men who don’t have private insurance may be covered by Medicaid family planning waivers in some states. Plus, both men and women can go to Title X clinics for sexual health education and counseling, birth control, STI testing and treatment, HIV testing, and in some cases vasectomy. Find a Title X clinic near you.
Men who rely on their partner using one of the methods covered for women by the ACA can still be involved in preventing pregnancy by supporting their partner. Ways to provide support include: learning about the method your partner is using, helping your partner remember to use her method, or going along to appointments—all depending on what kind of help your partner welcomes, obvs.
Some health plans have proactively chosen to cover men’s preventive care visits without out-of-pocket costs, but it’s not a requirement of the ACA like it is for women. The best way to find out what’s covered is to reach out to your insurance company. And if your plan isn’t meeting you needs, consider shopping around during the next open enrollment period!
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