Birth Control FAQ

Birth Control FAQ You might have heard that birth control may be free as part of health care reform. Is your type covered? What about condo... thumbnail 1 summary

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You might have heard that birth control may be free as part of health care reform. Is your type covered? What about condoms? Are there any exceptions?
Here are answers to those and other common questions about birth control coverage as part of health care reform.

Will my birth control be free under the Affordable Care Act?

You will not have a copay or other out-of-pocket costs for birth control, if you:

Get your health insurance through most employers, through your state's Marketplace, or from most private insurers, and
Have a doctor’s prescription for any type of birth control approved by the FDA. This includes the ones usually sold over the counter like spermicides and sponges.

Does every health insurance plan have to pay for birth control?

These terms of the Affordable Care Act apply only to new health insurance plans offered from your employer or that you buy on your own. Certain religious employers are exempt and do not have to include birth control benefits. Some private employers do not have to provide all forms of birth control if they object on religious grounds (see below).
Medicaid programs do not have to offer free birth control either, but most state Medicaid programs do cover prescription birth control methods.

Which types of birth control are free?

Birth control methods that are covered by this requirement of the Affordable Care Act include any that are approved by the FDA:

Birth control patch
Birth control pills
Birth control ring ( NuvaRing)
Birth control shot (Depo-Provera)
Cervical cap
Contraceptive implant
Diaphragm
IUD
Permanent contraception methods, such as tubal ligation, often called "getting your tubes tied"
Emergency contraception (Plan B, Ella, and Next Choice)

Your plan may also cover over-the-counter birth control, but you will need a prescription from your doctor if you want it to be covered without out-of-pocket costs.

Will my doctor exam also be free if I get a prescription for birth control at that appointment?

Often, yes. Your well-woman visits are covered with no out-of-pocket costs to you under the Affordable Care Act. During this visit, your doctor can tell you about the types of birth control and write you a prescription. However, if you get the prescription during a visit when you also get other services that don’t qualify for coverage with no out-of-pocket costs, you have to pay out-of-pocket costs for the visit.

Will my insurance cover the cost of over-the-counter female birth control methods?

Only if you have a prescription from your doctor. Over-the-counter birth control for women includes sponges, the female condom, and spermicides.
You'll still be able to buy them without a prescription, but you’ll have to pay for them on your own.

Where do I need to buy my birth control for it to be covered?

You don't have to change how or where you get it. You can get your birth control where you usually buy it: at your local pharmacy with a doctor's prescriptionP or through a mail order or online pharmacy. Your insurance company may, however, require you to go to an in-network provider or pharmacy.

Does the plan cover any other types of birth control services?

Yes. You also can get contraceptive counseling from your doctor at your well-woman visit at no additional charge. That includes information on:

The types of birth control that are available
How these methods work to prevent a pregnancy
Which type of birth control might be best for you

When does this new coverage start?

Most health insurance plans now cover birth control. Plans that existed before the health reform law may be grandfathered in and may not have to offer this coverage if they have not changed a lot. Check your policy or call your insurance company for information about your coverage.

Can I get brand-name birth control pills?

Insurance companies can charge you a copay, coinsurance, or deductible for a brand-name drug if a generic version is available unless your provider determines there is a medical reason why you need the brand-name drug instead of the generic.

Is birth control covered for men in health insurance plans?

No. Only women's birth control is covered. Health insurance companies do not have to pay for services related to a man’s reproductive capacity, such as condoms and vasectomies. In some states, Medicaid provides family planning services and supplies to eligible men and women under the state plan. Contact your local state Medicaid agency to see if you qualify for coverage for family planning services.

Are "morning-after" pills covered?

Emergency contraceptives, such as Plan B One-Step, Next Choice, and Ella, are covered when prescribed by a health care provider.

Do health insurance plans have to pay for "abortion pills"?

No. Health insurance plans are not required to pay for Mifeprex (mifepristone), a pill that induces abortions.

Who is now covered under Medicaid expansion?

The Affordable Care Act creates new opportunities for states to expand their Medicaid programs to cover individuals age 19-64 with incomes up to 138 percent of the federal poverty level. With this expansion, many more women may be eligible to get their birth control paid for by Medicaid. Go to Healthcare.gov's Medicaid expansion information to see if your state has expanded coverage. Also, some states have chosen a separate option created under the Affordable Care Act to provide family planning services and supplies to certain individuals; you can contact your state Medicaid agency to find out if you are eligible for coverage under this option.

How does the Supreme Court ruling affect birth control coverage?

The Supreme Court ruled that some for-profit companies do not have to provide the kinds of birth control that go against the company owners’ religious beliefs. But we don’t know yet how this decision will be put into effect. We also don’t know if women who work at these companies may be able to get access to all forms of birth control in another way.