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Important Federal Guidance on Birth Control Coverage

Healthy Futures of TexasMay 26, 2015Articles

The Patient Protection and Affordable Care Act (ACA) requires that private insurance companies cover women’s preventive health care, including all FDA approved contraceptive methods and services, without out-of-pocket patient cost. However, as demonstrated by the recently released reports by the Kaiser Family Foundation and National Women’s Law Center, many insurance companies are not providing coverage of some contraceptive methods; some are illegally required co-payments: and some are providing no coverage at all.

On May 11, the federal Health and Human Services (HHS) Department issued new guidance on the interpretation of the health law, in order to prevent insurance companies from denying coverage or requesting copayments. The guidance includes this Frequently Asked Questions list, which is summed up in The National Campaign for the Prevention of Teen Pregnancy press release:
  • Insurance plans must cover–without co-pays or deductibles–at least one form of contraception in each of the 18 FDA approved methods for women.
  • Associated clinical services, such as counseling, must be covered without cost-sharing.
  • Plans must offer a timely and easily accessible process by which a woman can get the method she and her provider determine is medically necessary (if the plan does not otherwise cover that method without cost sharing).
  • Plans must cover the full range of preventive services, including contraception, for all dependents.
Tiers EffectivenessSeveral resources to help women understand what their health insurance must cover include:
  • This chart published by the Kaiser Family Foundation lists exactly which forms of contraceptive methods should be covered.
  • The National Women’s Law Center created a hotline, Cover Her, for individuals needing help advocating for contraceptive method coverage with their insurance plans.
  • BuzzFeed created a What To Do If You Are Still Getting Charged list. These resources are helpful, but not everyone can fight insurance companies.
This Wall Street Journal article points out that, in addition to covering the cost of contraceptive methods, insurance plans must cover the cost of screening, counseling and genetic testing if a woman has an increased risk for breast cancer because of a gene mutation. Additionally, the New York Times points out that insurers must cover preventive services for transgender individuals and that “insurers cannot deny coverage or charge for ‘sex-specific recommended preventive services’ because of a person’s gender identity or the sex assigned at birth.”

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