Why isn’t my birth control covered for free under Obamacare?

*** post updated on 7/23/14 to include new information 

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Someone asked us:

I heard that birth control is free under Obamacare but I’m still paying for my pills every month. Why isn’t my insurance giving it to me for free?

There are a couple of reasons why this may happen. Here’s the deal:

Obamacare (sometimes called the health care law or the Affordable Care Act) is awesome because it recognizes that birth control is basic, preventive health care. It makes it so that most health insurance plans have to cover birth control for free without a copay.

At a minimum, health plans have to cover the full range of birth control methods without a copay if they are prescribed and FDA-approved. This can include:

  • birth control pills
  • vaginal rings
  • the patch
  • the shot (Depo)
  • implants
  • IUDs
  • female sterilization (plans are not required to cover vasectomies, but some might)
  • diaphragms
  • cervical caps
  • emergency contraception (aka the morning-after pill) if prescribed
  • spermicides if prescribed
  • sponges if prescribed
  • female condoms if prescribed

Most health plans must also cover your visit to the doctor to talk about your birth control options as well as services related to contraception — like follow-up visits, management of side effects, and IUD insertions and removals. This is with no out-of-pocket costs to you.

But, there are a few reasons why your insurance may not cover a type of birth control or may still charge a copay for your specific birth control.

Your health insurance plan is only required to cover one type of each birth control method (e.g., implant, IUD, sterilization, and hormonal birth control), but not necessarily all of the products in that category.  For example, if you use birth control pills, you might be able to get Ortho-Tri-Cyclen with no copay, but not Loestrin (another brand of birth control pills). Or the plan may cover a generic version of birth control pills with no copay, but charge a copay for the brand-name version.  

Plans must cover a brand name drug or a specific generic version if the version the plan covers with no copay is medically inappropriate for you. You and your nurse/doctor can talk about the methods that are best for you, and they’ll help you find the birth control that best meets your needs. 

If you and your nurse/doctor decide you need a specific birth control product that isn’t covered without a copay, you can request a “waiver” from your insurance company — this will allow you to use the brand name or specific generic without a copay. You can check with your insurance company for more information about the waiver process.

Another reason your birth control might have a copay is if your insurance plan is “grandfathered.” In other words, the plan doesn’t have to comply with certain standards under Obamacare because the plan already existed when the law was passed. So preventive care like birth control, STD screenings, and cervical cancer screenings might not be covered without a copay.

The good news is that more and more insurance plans will lose grandfathered status over time, usually when they make big changes to benefits, costs, and policies under the plan. If your plan loses its grandfathered status, your new plan must cover the full range of birth control methods for free without a copay.

Certain employers may also be permitted to refuse to cover birth control in their health insurance plans.  Churches and other religious houses of worship that are opposed to birth control do not have to provide employees birth control coverage. In addition, the U.S. Supreme Court recently ruled that two for-profit companies could refuse to cover birth control in their health plans due to religious objection. 

At this point, it’s unknown how many employers will use this Supreme Court decision to refuse to cover birth control or if the federal government will create another way for people employed at these companies to receive coverage. If your employer has indicated that it may refuse coverage of birth control, please contact the Planned Parenthood helpline by texting “birth control” to 69866.

Please note that some religiously affiliated nonprofit organizations (such as universities, hospitals, and charities) can refuse to cover birth control in their health plans, but the health insurance company must provide birth control without copay to employees.  As such, you should still receive no-cost birth control.   

This is all to say that insurance plans can vary a lot, so the best way to find out what’s covered is to call your insurance company. You should call the number on your insurance card and ask them questions directly. If you’re not getting the answers you need or access to the benefits you should, you can contact the Planned Parenthood text helpline by texting “birth control” to 69866.

And remember: whether you have insurance or not, you can always come to Planned Parenthood for the care you need, when you need it.

-Adriana at Planned Parenthood

How can I complain about my experience at a health center?

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Someone asked us: 

love planned parenthood but what do I do if I have a complaint about a visit? :(

Our health centers have been providing health care and education for a really long time. But we’re not perfect. So if you feel that your visit didn’t quite stack up, we want to hear about it.

The best thing that you can do to make sure your concerns are heard is to follow up with the health center manager at the Planned Parenthood you visited. Give them a ring and tell them about your experience. They’ll make sure that your complaint is addressed and that you get the care you need.

(On the flip side, if you have a super-awesome-wowza experience, you can also call the health center manager and let them know. They work so hard and appreciate the love. <3) 

Coming forward about a negative experience won’t just make you feel better; it’ll also help us improve things for the next person who walks in the door. So thanks for helping us further our mission and provide the best care possible – you deserve a thousand high-fives.

-Chelsea @ Planned Parenthood

ppaction:

Timeline: 100 Years of Birth Control

Since Planned Parenthood founder Margaret Sanger coined the term “birth control” in 1914, contraception has truly revolutionized women’s lives in the United States, and around the world. Brush up on your birth control history, and see just how far we’ve come in 100 years.

SEE THE HIRES VERSION HERE

Does STD testing need to include a vaginal exam?

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Someone asked us: 

Hello, I am a female-bodied trans* person under the age of 18. I need to go get tested for STDs at a Planned Parenthood office and I would like to know if that would have to include a vaginal examination because I have really bad body dysphoria and I would like to avoid that at all costs.

First, the good news:  Current medical guidelines recommend having your first pelvic exam (where a doctor checks the vulva, vagina, cervix, uterus, ovaries, and fallopian tubes) and Pap test (where the cervix is tested for abnormal cell changes) after you turn 21, so you have a few years to go before you should start getting regular pelvic exams, as long as you’re not having any problems before then.

Most STDs can be detected using a simple urine or blood test, so you may not need to have a vaginal exam. However, some STDs are diagnosed by looking at your genitals (genital warts), or with fluid taken from a sore (herpes, syphilis). Your nurse or doctor may need a sample of vaginal, cervical, or anal discharge or cells to diagnose some other STDs.

So your STD testing experience depends on the types of STDs you may be at risk for. However, nurses and doctors will do everything possible to make your appointment more comfortable. For example, some doctors now allow patients to collect certain discharge samples themselves by having them swab their own genitals privately, so you can ask if that’s an option for you.

Body dysphoria is serious stuff, so getting support to help you cope is an important part of being healthy, just like STD testing. Your nurse or doctor could be a good source of support, so talk with them about your concerns before or during your appointment. They can give you tips to help you feel better prepared for pelvic exams and Pap tests when you’re old enough to get them. If you don’t feel comfortable talking about your concerns with a nurse or doctor, a trans-friendly counselor is another good source of support.

-Mylanie at Planned Parenthood

We’re Glad You Asked…

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Got a burning question? Here’s what you should know before you submit a question to the Planned Parenthood tumblr Team:

  1. If what’s going on could be an emergency, get off tumblr and call emergency services (911 in the USA).

  2. Chances are we’ve already answered your question, so check our tags, archives, or website to get info ASAP.

  3. Submitting questions/comments to us gives us the okay to share it publicly on our page. (We’ll never share your identity or tumblr handle without your permission.)

  4. Sorry, we can’t guarantee a response. We try our best to read and answer as many questions as possible, but we get a ton of submissions.

  5. Most questions won’t be answered right away. If you want answers quickly, use our chat/text program to live-chat with a health educator. You can also contact your local Planned Parenthood health center.

  6. Please keep it short and sweet. Questions are usually published unaltered, but we may edit for content and length.

  7. Although we try our best to be a helpful resource for our followers, there are some things we can’t do here on the internet: diagnose you with an illness; know if you’re pregnant; make or cancel an appointment at any of our health centers; change your prescriptions; or contact your doctor. You can talk with your health care provider about this stuff.

  8. Politically active? Great! So is the Planned Parenthood Action Fund. If you’re interested in protests, rallies, politics, and other advocacy info, check out the PP Action tumblr.

  9. This blog is for informational purposes only and is not intended to replace medical advice, diagnosis, or treatment. If you have a medical problem, please call toll-free 1-800-230-PLAN to make an appointment with the Planned Parenthood health center nearest you.

If you read all of our guidelines, you deserve a silly animal gif. So here’s a chow puppy stuck in a bowl