The Affordable Care Act mandates that most private health plans cover women's preventive healthcare--including all prescribed Food and Drug Administration-approved contraceptives--without cost-sharing. But not every insurer follows this requirement.
A recent Kaiser Family Foundation report examined insurance policies for 12 prescribed contraceptive methods from 20 different health plans in five states to gauge how the interpretation of the provision varies across plans. Here are some key findings from the report:
Plans place limits on certain contraceptive methods. Twelve of the 20 plans reviewed cover NuvaRing with no cost-sharing for women. Five plans cover NuvaRing with cost-sharing and one plan does not cover it at all. For contraceptive implants, some plans place limitations on coverage while two plans don't cover implants, even with cost-sharing.
Plans lack processes for waiving coverage limitations. The Department of Labor requires plans to have a process in place for waiving coverage limitations for women who have a medical need for contraceptives that are not covered by their plan. None of the plans reviewed established such a process, nor was it clear if any plans have an expedited appeal process that would allow women access to emergency contraceptives not covered by their insurer.
Sterilization coverage remains up for debate. Ten plans cover sterilizations without cost-sharing. However, KFF was unable to determine the extent of coverage for ancillary services associated with sterilization, such as follow up visits and anesthesia.
For many women, the ACA's contraceptive coverage provision has reduced their out-of-pocket costs and provided them with more affordable and accessible contraceptive methods, KFF concluded.
However, insurers have used these federal regulations to their advantage to exclude generic versions of contraception from free coverage. For instance, some insurers move generic birth control pills from the zero co-payment tier into a higher tier with a monthly payment, FierceHealthPayer previously reported.
- here's the KFF report