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Is birth control now covered by health insurance?

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Keep in mind...
  • The Affordable Care Act mandates that your insurance plan cover one type of birth control per person with no out of pocket costs
  • There are some exemptions to this rule
  • Health plans are not required to cover drugs to induce abortions or services that limit a male’s reproductive ability
  • There are 18 contraception categories and your insurance must cover one type from each of these categories
  • Some religious organizations and other related nonprofit organizations are not required to offer this coverage to their employees

Is birth control covered by my health insurance?

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The Affordable Care Act requires marketplace plans and private employer-based insurance plans to cover birth control. This is known as the contraceptive coverage guarantee. One type of birth control from each of the 18 contraception categories must be covered. All contraceptives may not necessarily be free under the ACA, and you might be responsible for some sort of copayment, depending on the type and brand.

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What services are covered under this mandate?

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One type of birth control from each of the 18 contraception categories must be covered without the patient being responsible for paying a fee. However, your insurer can choose to limit these free options to generic medications and only certain types of devices. They will still be available to you but you will be expected to pay a co-payment in order to receive them.

Additionally, other women’s health and preventative services must be covered for free. This includes pap smears, cancer and diabetes screenings, and prenatal screenings. You will have to contact your insurance company directly to find out specific services they will cover.

What are the 18 types of contraception?

The 18 types of contraception include female sterilization surgery, an implantable rod, surgical sterilization implant, and a diaphragm. Additionally, intrauterine devices, whether they are made of copper or hormonal with progestin are both covered.

Birth control patches and injections are covered, as well as almost all oral contraceptives, which means those that include only progestin, those that include progestin and estrogen, and continuous use pills that put off menstruation. Vaginal contraceptive rings, sponges, spermicide, female condoms, and cervical caps are all covered.

Emergency contraception, such as the plan B bill and another type of oral medication known as Ella, are all also required coverage.

Additionally, patient education and counseling on contraceptive methods are also covered.

Which medical services are not required to be covered?

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Health insurance plans are not required to cover any drugs that can cause an abortion or any surgeries and services that affect male reproduction, such as vasectomies. Additionally, most name brand drugs will not be covered free of cost, unless it is deemed medically necessary for you. All plans are only required to cover one type, so be sure to check your plan to make sure the one that your doctor prescribes for you is covered.

Are there exemptions to this mandate?

There are a few exemptions to this mandate. If you work for a religious employer, such as a church or other house of worship, they are not required to cover any forms of contraception or relevant counseling, at all. You may have to pay for these services out of pocket, but your employer does not have to offer it, even through a separate insurer.

If you work for another type of religious organization, such as a nonprofit organization, hospital, or institute of higher education, that object to contraceptives based on religious grounds, your employer is exempt from arranging or paying for your contraceptive coverage, but you do have options. Employees of religious-affiliated organizations are eligible to get their birth control covered by a separate insurance entity, as long as they are on their

If you work for another type of religious organization, such as a nonprofit organization, hospital, or institute of higher education, that object to contraceptives based on religious grounds, your employer is exempt from arranging or paying for your contraceptive coverage, but you do have options.

Employees of religious-affiliated organizations are eligible to get their birth control covered by a separate insurance entity, as long as they are on their employee’s health plan. In order for your employer to qualify for this exemption and have your coverage covered elsewhere, they must write a letter to the Department of Health and Human Services and they will contact the third party insurer and make the arrangements.

Short-term and temporary insurance plans are also unlikely to offer free birth control coverage, as these plans do not have to meet Affordable Care Act minimum essential coverage guidelines, either. However, short term coverage does not exempt you from having to pay the Affordable Care Act individual mandate penalty fine, since it does not meet these regulations. It is mostly just to help with gaps in coverage or if you are in between coverage.

What are my options if I don’t have health insurance?

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If are not covered by any health plan at all, you may still have options for getting free or low-cost birth control coverage. Some public health clinics, such as Planned Parenthood, offer free women’s services, which can include birth control if you have a low income and have no health insurance. If this option does not work for you based on your income or limited options in your area, your pharmacy may be a good resource in offering generic birth control at a lower cost if you pay cash.

There are also free RX cards available online that may be helpful. If do have a lower income and do not have insurance because you think you cannot afford it, you should look into Medicaid and low-cost subsidized insurance programs through the Health Insurance Marketplace.

The Affordable Care Act does require health insurance plans to cover birth control.They must cover at least one option from each of the 18 types of contraception for free, although they are usually the generic version. Religious employers are exempt from this mandate, as are grandfathered plans and short term insurance.

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