Access to effective birth control is important to a woman’s health. That’s why the Affordable Care Act requires that health insurers provide cost-free contraception coverage. And in the wake of the Supreme Court’s decision overturning Roe v. Wade, access has perhaps never been more vital.
It sounds simple, right? The ACA requirement should be met by every health insurance plan across the country. Instead, it’s complicated.
There are health plans whose non-compliance with the ACA has been grandfathered in. Others barely comply with the law or find ways to get around the spirit of it. Even with plans that are compliant, precisely what’s covered can be confusing.
If you’re like most women, you’re at the mercy of complex insurance policy language, restrictions, and requirements. All you want is to effectively prevent pregnancy, but many insurance companies throw up barriers. Here’s how you can remove some of them and make the process a bit easier on yourself.
Know What Your Plan Does and Does Not Cover
If you have ever attempted to read your health insurance policy, you may think it’s written in a foreign language. You have likely experienced the common coverage-coinsurance-copay confusion. At the end of the policy, you still aren’t sure what birth control is covered and what isn’t.
If you don’t know what contraceptive coverage the ACA requires plans to cover at no cost to you, you should. It requires coverage of at least one form of contraception in each of 18 FDA-approved categories. Those range from emergency contraception to sterilization surgery and everything in between.
However, not all health plans comply fully or at all. Some may cover some brands of the pill but won’t cover name-brand versions of the birth control ring because they’re more expensive. Other plans claim exemptions based on religious grounds.
Some plans actually impose a “step therapy” requirement before it will agree to cover a particular name brand over a generic. For example, you may be required to try and fail in using three or more before the plan may approve the one you requested. “Try and fail” isn’t what you want to hear when dealing with contraception.
Other plans may cover the cost of an IUD but require healthcare providers to seek approval before prescribing one. Or they may pay the cost of the device but not for the ultrasound used during the insertion process.
How do you know what your plan will cover? If you have an employer-provided plan, you should check with the human resources department. If not, or if HR doesn’t know, you will need to call the plan and talk to a representative.
Finally, you can always ask your online provider, doctor, or pharmacist to check what your plan will cover. They want to get paid, so they’ll do a preapproval check for you.
Determine the Best Contraception for You
There are really two ways to approach using your health insurance to cover the cost of birth control. You can find out what your plan covers and choose from those options. Or you can determine what method is the best option for you and figure out what plan will cover the cost.
Birth control is not a one-size-fits-all proposition because there are far too many moving parts. Personal preference, lifestyle, side effects, child-bearing intentions, and sexually transmitted infection protection are a few of them. All play a role in the decision-making process, and each plays out differently for individual women.
You may not want to use any form of hormonal birth control or a method that causes you to suffer side effects. You may not want to take a pill daily or stop during a heated moment to employ a barrier method. You may need a method you can use while breastfeeding or one that’s safe to stop and allow pregnancy right away.
Ultimately, the choice of birth control should be yours. It’s wise to discuss options with your healthcare provider so you’re armed with the information you need to make it. Your doctor’s opinion may also be a weapon you can use if your plan doesn’t want to cover your choice.
Most health insurance plans, but not all, offer an appeals process should they deny coverage of your preferred method. If your plan prohibits appeals or if your appeal is denied, you do have other options. You can look for plans that cover the cost of your preferred method without cost sharing.
ACA Marketplace plans may be your best shot if your employer-provided or other private plan shuts you down. If your employer is paying all or most of the cost of your plan, you may need to stick with it. If you do, you’ll need to discuss with your doctor your best option for what is covered by the plan.
On the other hand, if you’re paying the cost of your insurance anyway, pay for what you want. For example, when you search for a Marketplace plan, you can plug in your birth control preference as a filter. If you’re shopping for a non-Marketplace individual plan, make sure your choice of contraception is a priority.
Getting Your Ducks in a Row
If you’re taking a prescription medication for high blood pressure, you want to make sure your health plan will cover it. It’s not something you can stop taking without suffering serious consequences. Your birth control is no different.
Work with your healthcare provider to explore your options and choose the best method for you. Find out if your insurer will cover the cost of it in full. If it won’t, you need to find a plan that will or choose another form of birth control.
The best way to make the insurance process easier when it comes to contraception is to be in the know. Learn what should be covered, what is covered in your plan, and what you want covered. That way, there will be no surprises when you take steps to protect your health.
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