Will Health Insurance Cover Birth Control?
Birth control coverage is an important issue for women and families. Unplanned pregnancies can be devastating from a financial point of view, even if the baby is welcomed and wanted. Many women rely on birth control to plan their families in accordance with their personal and financial realities; however, birth control is not always covered by health insurance policies. This has caused many women’s groups to advocate for the government to intervene and force insurance companies to cover birth control.
Methods of Birth Control
Women have many options when it comes to birth control. By far the most popular method is “the Pill,” the name given to oral contraceptives. According to the National Institute of Health, oral contraceptives are usually prescribed in dosages of two important hormones: estrogen and progestin. While the exact compounds and dosages may vary by brand, all oral contraceptives work on a similar system. The Pill essentially tricks the body into thinking that ovulation has taken place, even though the egg has not been released from the ovaries. While the Pill has been shown to be very effective at reducing pregnancy rates, there is a slight chance women can still become pregnant while on the Pill.
Another type of hormone-based contraceptive is the injection known as Depo Provera or just “Depo.” A Depo shot lasts three months and works in much the same way as the Pill. There are also implants and patches that work in a fashion similar to the Depo shot.
Another method of birth control is the IUD or intra-uterine device. These devices, which fit inside the uterus and prevent implantation of a fertilized egg, are the most initially expensive, costing up to $1,000 for the device and for medical treatment to insert it. However, they last up to 12 years, making their overall cost very low when compared to monthly pills or shots.
Finally, the diaphragm is another birth control device that many women choose because it does not involve surgical procedures or hormones. A diaphragm is a small rubber cap that fits over the cervix and prevents the entrance of sperm. Diaphragms are relatively inexpensive and provide a good birth control alternative for women who have sex occasionally but do not want to take hormone-based pills every day.
No birth control method is one hundred percent effective, besides abstinence from sexual activity. No birth control method besides condoms provides any protection from STDs including HIV, the virus that causes AIDS.
Does My Health Insurance Cover Birth Control?
Under the Affordable Care Act, most forms of birth control are required to be covered by employer-sponsored healthcare plans, according to the National Women’s Law Center. However, this seemingly simple statement is fraught with issues that are leaving some women wondering where the “free birth control” idea came from.
For example, the ACA requires all employer-sponsored health care plans to supply birth control with no co-pays or deductibles. However, in practice this may not cover a particular brand of birth control or a particular type. The ACA specifically covers birth control pills, IUDs, and diaphragms, but your insurance company’s formulary may not treat certain brands as Tier I medications. In that case, you may have to pay out-of-pocket costs.
Furthermore, if you already had insurance before the ACA took effect, your insurance provider is likely “grandfathered” into the plan. This means that your company is not required to pay for your birth control if it did not pay before until it makes significant changes to its plan coverage. If your premiums go up by more than five percent, for example, your company will be required to offer birth control under the new law.
Many health insurance plans such as HMOs already cover certain birth control devices and medications at a 100 percent rate. In order to determine if your birth control method is covered, visit your insurer’s website or call the company and ask about specific products.
What If I Want To Change Birth Control Methods?
Your doctor must prescribe whatever birth control method you use in order for your insurance company to pay for it. Condoms are not covered, for example, because anyone can purchase them at any time. If you are interested in changing birth control methods, you must talk to your doctor about a new prescription. It may also pay to do a bit of research with your insurance company to determine how much of the cost of the new method will be covered under your plan.