*** post updated on 7/23/14 to include new information
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:
- female sterilization (plans are not required to cover vasectomies, but some might)
- emergency contraception (aka the morning-after pill) if prescribed
- spermicides 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