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

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 = amazing because it recognizes that birth control is basic, preventive health care. It makes it so that new insurance plans have to cover birth control (along with a whole host of other preventive care) with no out-of-pocket costs to you.

At a minimum, plans have to cover the full range of contraceptive methods without a co-pay 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

  • emergency contraception (aka the morning-after pill) if prescribed

  • spermicides if prescribed

  • sponges if prescribed

New 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 specific type of birth control at no cost.

Your 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 want use birth control pills, you might be able to get Ortho-Tri-Cyclen at no cost, but not Loestrin. Or they may cover a generic brand of birth control pills at no cost, but require a co-pay for the brand-name version.  

Plans must cover a brand name drug or a specific generic version if there’s a medical reason you need to use it over the version your plan covers. You can ask your nurse or doctor what methods are best for you, and they’ll help you request a “waiver” from your insurance company — this will allow you to use the brand name product or specific generic without a co-pay.  You also want to ask your insurance company to check what the process is.

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

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 range of birth control methods without a co-pay.

Insurance plans can vary a lot, so the best way to find out what’s covered or if your plan is grandfathered is to call your insurance company. If you’re not getting the answers you need or access to the benefits you should, you can call the National Women’s Law Center PILL4US hotline at 1-866-PILL4US for additional help.

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