Does Health Insurance Cover Condoms?
As reproductive care costs soar, insurance for birth control has become an increasingly important issue for Americans. While there is a range of birth control methods available today, condoms are a leading choice of contraception for disease and pregnancy prevention.
In spite of their popularity, most health insurance companies do not cover condoms under their plans at the present time. However, this might be set to change under the edicts of the 2010 Patient Protection and Affordable Care Act. Under the new law, women with health insurance are likely to have access to condoms, with a prescription and without a co-pay. However, men do not have this option available to them.
But like any other new law, the language of the Affordable Care Act has been found to be confusing for consumers and insurance providers alike. So if the lack of details is frustrating you, make sure you talk to your insurance provider and get answers for your birth control questions.
The Affordable Care Act and Contraception?
This new law requires insurance companies to cover a list of reproductive services for women without any out-of-pocket expenses. The intention is to allow women access to contraception and preventative services without the financial burden of co-pays or deductibles.
The list of no-cost services includes: well woman visits; screening for gestational diabetes, STDs, and HIV; PAP smears; testing for human Papillomavirus; counseling for STDs; and providing contraception, among others.
While the other services are clearly stated, the list of contraceptive options lacks clarity. The Affordable Care Act states that all Food and Drug Administration (FDA) approved methods of contraception, sterilization, and counseling for women are to be covered by insurance plans at no cost.
What are FDA-Approved Methods of Contraception?
Based on input from the Institute of Medicine, the Health and Human Services Department (HHS) of the government has put forth a set of rules. The emphasis is on prevention and early detection of reproductive problems in women.
Under these guidelines, all physical and hormonal methods of contraception available to women, such as diaphragms, cervical caps, IUDs, birth control pills, implants, injections, and emergency contraceptives such as Plan B are covered. It also includes sterilization for women as a method of birth control.
Why Aren’t Condoms Automatically Included in the List of Free Contraception?
According to the HHS, the women’s preventative services guidelines are meant for women exclusively. Since condoms are considered a male-based contraceptive method, they are presently excluded from this list.
However, this specific aspect has caused a lot of confusion since statistics show that women actively buy and use condoms as contraception. According to the Centers for Disease Control and Prevention, condoms are one of the top five methods of birth control used by women today. As the administration clarifies its position, there is a possibility that women might be able to get free condoms with a prescription in the near future.
Does My Health Insurance Policy Cover Birth Control?
The simplest answer to this question is: Ask them. Talk to your employer’s benefits administration department as well as your insurance provider about your birth control options. Ask specific questions about coverage of brands and types of birth control that you prefer to use.
The Affordable Care Act requires employer-based and private healthcare plans to cover most forms of women-centric birth control without co-pay or deductions. But this does not mean universal coverage of all brands and types of contraception.
While the law covers IUDs, diaphragms, and birth control pills, it allows insurance companies to limit free coverage to certain generic drugs and devices. If you choose to use a brand that is not part of the free group, you may have to pay for it. Your access to free birth control and preventative services might not kick in immediately. Depending on the type of health plan you are on, it could take a few months or more.
Additionally, this law has a “grandfather” clause. Simply put, if your company provided you with a certain plan that did not cover you for birth control before the new Act was instituted, then you might not be eligible for free birth control. However, if your cost of birth control rises significantly, your company is required to cover you for free FDA-approved birth control.
Given the difficult language and spread of the Affordable Care Act, you might be best served by talking to a representative of your insurance service provider or visiting their website to get some answers.
Can I Change My Form of Birth Control?
If you want to move to a new method of birth control, you will need a prescription from your doctor. But before asking for a new scrip, do some research on your insurance company’s website to determine the cost of your new contraception. Look at the different options they provide. If your chosen method falls “out of network” and is too expensive, you might find other acceptable methods that are cheaper or free.