Still Paying For Birth Control? 9 Reasons Why Your Contraceptives May Not Be Covered By The Affordable Care Act
After the implementation of the Affordable Care Act's contraception mandate, many of us thought that the days of women paying out-of-pocket for birth control were over. That's because Obamacare requires insurers to cover contraception with no co-pays, deductibles or other cost-sharing. The "free birth control" aspect of the ACA became one of its most exciting and most controversial elements in the years leading up to its passage — years that were full of American women dreaming of a future where they wouldn't have to go broke paying for their reproductive health.
However, researchers from the University of Pennsylvania studied data from one large private insurer, and found that most women were paying $20 a month for birth control after the ACA went into action — down from the $41 they were paying each month before the ACA. Yup — women were still paying $20 per month (which adds up to $240 per year) for their birth control after the rule went into effect. And in fact, many women still continue to paying for their birth control today.
This is because numerous cracks remain in the contraceptive mandate, even since the government issued additional guidance in May 2015. Are they impacting your life, health and/ or wallet? Here are 9 the reasons you might still be shelling out for your BC.
1. You Want To Stick With Your Tried-And-True Method
...but your health insurance plan wants you to use a cheaper type. They can do that. The law allows health insurers to use "reasonable medical management" to keep their costs under control. That often means steering people away from more expensive drugs and towards cheaper ones. Technically, an insurance company can comply with the Affordable Care Act by offering just one product in each FDA approved category of contraception for free.
So, for example, an insurance company may offer only one version of the combined birth control pill that has no cost-sharing for enrollees; the dozens of other available types may require a co-pay or might not be covered at all.
A look at some plans offered on federal and state exchanges shows that many insurance companies cover multiple types of contraception within each method with no cost-sharing — but not all of them. If you want to use an uncovered type, and your doctor won’t tell the insurer that it’s medically necessary for you to use it, you’ll have to pay for it — in some cases, you may be asked to pay the entire cost on your own.
2. You’re On A "Grandfathered" Plan
There’s no getting around this one. Plans that have been in place since March of 2010 (when the ACA was enacted) and haven't changed substantially in terms of cost or coverage are "grandfathered" in — which means that they still aren’t subject to the contraceptive coverage mandate. If you're on one of these plans, you’ll pay whatever the insurer says you'll pay for your birth control. About a third of the plans surveyed in the UPenn study were grandfathered when the contraceptive mandate went into effect in 2013. These plans are likely to be phased out over time, as they eventually make adjustments to their terms — but for now, they can add some extra financial stress to your life.
3. Your Employer Has A Religious Exemption
Maybe you're a choir director or a nun. If your employer is a house of worship, it does not have to pay for birth control (despite the fact that many women use hormonal birth control for reasons besides pregnancy prevention). Other religious non-profits can also refuse to offer contraception — however, they must make it available to employees through a third party. A similar accommodation will likely be required for the for-profit companies who got an exception based on the Supreme Court case, Burwell v. Hobby Lobby. Those details are still being ironed out.
4. You Use An Over-The-Counter Method Covered By The ACA, But You Don't Have A Prescription
Count yourself among the small percentage of women of childbearing age who use a method of birth control that’s not the Pill, patch, IUD, ring, or one of the other big guns. Maybe yours is even OTC, like female condoms or spermicide. Good news — those items can be covered by insurance, but you have to get a prescription first. (Yeah, it kinda defeats the whole purpose of being OTC.) Same thing goes for emergency contraception — with a prescription, it's yours for free. Without one, you'll have to pay full freight. So if you do use an OTC method, make sure to ask your gyno about it during your next appointment
5. You Used An Out-Of-Network Pharmacy
C'mon now! You're just making things hard on yourself. You may use a pharmacy near your house, rather than an in-network pharmacy, to save time, but you're costing yourself a ton of money in the process. To get the full benefits from your insurance company for things like contraceptive coverage, you have to fill your prescription at an in-network pharmacy, as your insurer negotiates specific rates with them.
6. You Lost Your Pills And Need A Replacement Pack
Many insurance companies impose limitations on how often they’ll pay for certain prescriptions. If you fill one before the necessary time period has passed, you'll have to pay. It's not a fair rule, and certainly not one made by someone who understand how easy it is for those little suckers to fall out of your bag or get left behind at the beach house. If you want to continue their contraceptive effects, you'll need to consult your health care provider as soon as you realize you've lost them and get a replacement pack ASAP. But you'll probably have to pay for these pills yourself.
7. You Use Male Condoms (Or Another Form Of Male Birth Control)
More than 15 percent of women trying to avoid a pregnancy rely on male condoms, but this is an expense you and/or your partner will have to fund yourselves. They’re not covered under the Affordable Care Act. Female condoms, on the other hand, will be free with a prescription.
A vasectomy may be partially covered under the ACA (check with his insurer) though it could result in certain out-of-pocket charges. Female sterilization procedures — including counseling and follow-up care — should be fully covered with no cost-sharing.
8. Your Doctor Hasn't Said That Your Type Of BC Is Medically Necessary For You
The May 2015 guidance emphasized that ultimately, doctors get to decide which contraceptive is best for their patients. And if that method isn’t covered with zero cost-sharing according to insurance documents, the insurer is required to make an exception. The catch is that the doctor’s office has to communicate that directly to your insurer.
If you’d like to start — or stick with — a type of contraception that isn't covered without cost-sharing, ask your doctor to fight for you.
9. You Don't Have Health Insurance
Today, 88.1 percent of Americans have health insurance — more than ever before, which is a great thing. But those numbers mean that 11.9 percent of Americans are still going without health insurance, which means that those people are paying for birth control out-of-pocket, too — though paying for contraceptives is probably the least of your financial worries if you're going without health insurance. If you decide to have a baby, for instance, the average cost of a vaginal birth is between $12,000 and $16,000, while the average cost of a C-section is between $20,000 and $25,000. And the cost of recovering from a serious illness or injury can rise far higher.
If you don't have health insurance, but then find out that you're pregnant and want to sign up, there's some bad news: getting pregnant is not always considered a qualifying life event which would allow you to sign up for health insurance on the federal or state exchange, outside the open enrollment period, though some advocates are trying to change that. In the meantime, many states expand Medicaid coverage or have insurance programs for lower-income pregnant women.
So yes, it turns out we didn't all get the "free birth control" that we thought was on the horizon. But if you're currently paying out-of-pocket, you may have more options than you thought.
Images: Caroline (OMG She's The Best) Wurtzel/Bustle; Giphy (9)