A woman hands another woman a birth control prescription

Private and Public Insurance Coverage for Contraception

Private and Public Insurance Coverage

The Affordable Care Act (ACA) strengthened affordable access to contraception by expanding the number of Americans with public or private health insurance and eliminating cost sharing for contraception. Scroll down for more background on Medicaid and the ACA's provision on no co-pay birth control.

WHY IS CONTRACEPTIVE ACCESS IMPORTANT?

When people have the power to decide if, when, and under what circumstances to get pregnant and have a child, they have the opportunity to pursue the future they want for themselves. But they can’t make that decision if they lack access to information and contraception.

Yet, more than 19 million women of reproductive age living in the US in need of publicly funded contraception live in contraceptive deserts—counties where they lack reasonable access to a clinic offering the full range of contraceptive methods. Nearly 1.2 million of these women live in counties without a single clinic offering the full range of contraceptive methods. These barriers to contraceptive access fall hardest on those who disproportionately lack access to the birth control method they need, namely people of color, people living in rural areas, and people struggling to make ends meet. Many of these people also depend on safety-net programs like Medicaid and the Title X Family Planning Program for their coverage and access to affordable contraception. Together with insurance coverage from the Affordable Care Act (ACA) and particularly its requirement that contraception be covered without co-pays or deductibles, these programs and policies form a web that aims to ensure contraceptive coverage and access for as many as possible. However, this web was never adequate to overcome all the barriers people face and has itself been significantly damaged in recent years. This damage must be undone, but in doing so we must also work to build a system that truly meets everyone’s contraceptive needs—focusing on those who face the greatest barriers to contraceptive care.

NO CO-PAY BIRTH CONTROL

About No Co-Pay Birth Control: Thanks to the Women’s Preventive Services provision of the ACA, women covered by Medicaid expansion, marketplace, and employer-based plans are not required to pay extra out-of-pocket costs for women’s preventive services, which includes birth control. An estimated 62.1 million women benefit from the Women’s Preventive Services provision. Women also saved at least $1.4 billion in out-of-pocket costs for birth control pills in a single year, and there is evidence that the provision is increasing the ability of women to obtain more effective birth control methods for those who want it.

Current Status: In Effect, with Broad Exemptions  

On July 8, 2020, the US Supreme Court released its decision in Trump v Pennsylvania. The ruling allows employers and universities to opt out of covering birth control in their insurance plans for just about any reason—leaving women covered by those plans to shoulder the full cost of their birth control without any insurance coverage. While it is unclear how many people may be impacted by this, employers are now permitted to exclude contraception from their plans as the fight will continue in the lower court.  The Court ruled that this was within the Trump Administration's executive authority to do, and President Biden committed during the campaign to undoing these regulations. The Biden Administration is expected to release new draft rules in 2022.   

In addition, as new methods of birth control become available, we know people sometimes struggle to get their insurance plan to cover those methods:

  • In response to stakeholder feedback about some plans not complying with the Affordable Care Act’s Birth Control Benefit, on January 10, the Biden-Harris Administration issued guidance to make sure insurance plans cover the birth control you and your provider decide is right for you, without co-pays or deductibles. Additionally, the guidance directs consumers to report plans that are not covering their birth control as required. If you are facing this issue, please read Power to Decide’s blog post on how to report your plan.
  • In May 2022, Power to Decide released a new report When Your Birth Control Isn't Covered that reveals troubling new evidence of health insurance companies failing to provide coverage of the full range of birth control options with no out-of-pocket expense, as required under the Affordable Care Act (ACA).
  • On July 28, the Biden-Harris Administration released updated guidance that reaffirms several important standards outlined in the ACA, including the requirement that health insurance companies provide a transparent and easy-to-use exceptions process to help patients get coverage of the contraceptive method that works for them in cases when it is not typically covered by their plan. See Power to Decide's press release on this guidance.  

Finally, we know that over-the-counter methods like some forms of emergency contraception and internal condoms are not covered by insurance unless you have a prescription. This is already a problem for people using those methods, and it could become an even bigger problem in the future if some birth control pills become available over the counter

MEDICAID

Current Status: The Biden-Harris Administration has signaled their intent to reverse policies that make it more difficult for people to gain coverage through Medicaid but Congress must also support policies that expand Medicaid coverage and access to services.

While the barriers approved by the Trump Administration are being challenged in the courts, it’s important for the federal government not to approve state Medicaid waivers that put up additional barriers to reproductive health care and should also take steps to end existing waivers of that nature. Any cuts or restrictions that reduce access to Medicaid or the contraceptive care it covers undercut contraceptive coverage and access at the same time as states are looking for opportunities to expand that coverage and access.

About Medicaid: The Medicaid program is a partnership between states and the federal government, with several different pathways to eligibility. States have been required to cover family planning services for reproductive age beneficiaries since 1972. States also have the option to provide a more limited set of benefits, such as family planning services, to those with income above the traditional Medicaid eligibility levels. Twenty-six states have federal Medicaid Family Planning expansions. In addition, 39 states (including Washington, DC) have implemented the full Medicaid expansion, in order to provide health insurance coverage to low-income, non-disabled adults (a group that was not eligible under traditional Medicaid), as the ACA allows. Medicaid plays a vital role in offering contraception to low-income individuals, accounting for 75% of public spending on family planning.

ADDITIONAL RESOURCES

Power to Decide: When Your Birth Control Isn't Covered - This report reveals troubling evidence of health insurance companies failing to provide coverage of the full range of birth control options with no out-of-pocket expense, as required under the Affordable Care Act (ACA). 

Power to Decide: Federal Policy Agenda 2021-2022 - This agenda summarizes Power to Decide’s federal policy priorities, which broadly fall into three categories: information, access, and opportunity.

Birth control access map - More than nineteen million women in need of public funding for contraception live in contraceptive deserts (meaning they lack “reasonable access” to a public clinic with the full range of methods). See how your state compares.

Kaiser Family Foundation: State and Federal Contraceptive Coverage Requirements—Implications for Women and Employers - This issue brief summarizes the continuing litigation on the federal contraceptive requirement and explains the interplay between the federal and state contraceptive coverage laws.

Polling on the popularity of birth control:

Key Messages on Birth Control Coverage and Access

  • 75% of adults favor continuing the Title X Program, including 66% of Republicans and 84% of Democrats.
  • 78% of adults agree that birth control is a basic part of women’s health care.
  • More than 90% of all Americans (across political parties, race, and ethnicity) agree that for those trying not to get pregnant, using birth control is taking personal responsibility.