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Contraceptive Coverage in the Health Care Law: What’s New as of August 1, 2012?

For a PDF version of this factsheet with footnotes please see below.

On August 1, 2012, provisions in the health care law requiring insurance companies to cover contraceptives with no co-pay went into effect.  In the next few years, as an increasing number of health plans come under the law’s reach, more and more women will have access to all of the FDA-approved forms of contraception with no co-pay. This means that eventually all women with private insurance will get the full range of FDA-approved birth control methods, including oral contraception (the pill), injectables, the ring, contraceptive implants, diaphragms, cervical caps, and non-surgical permanent contraceptives without paying a co-payment or having the costs applied to her deductible.*  Sterilization for women is also covered with no co-pay or deductible.

* Insurance companies do have some flexibility in implementing this new requirement, like being able to charge a co-pay for a brand name drug where generic equivalents exist. 

(For more information on contraceptive coverage and coverage of preventive health services generally, please see Contraceptive Coverage in the Health Care Law: Frequently Asked Questions.)

 

Does this mean that I now have access to birth control with no co-pay?

The August 1st implementation date means that “new” private health insurance plans must include this coverage at the start of their next plan year on or after August 1st.   Your access to this coverage will depend on when your plan’s new year begins.  

Most private insurance plan years begin on January 1, so they will be required to offer this coverage as of January 1, 2013.  However, some plans began offering this new benefit as of August 1. For example, school health plans should already be providing contraceptive coverage because most begin their health plan years around the beginning of the school year. And some private insurance plans started providing some of the preventive services in advance of their new plan year -- so you may already be covered.

I heard that some plans do not have to cover this benefit because they are “grandfathered” and not “new.”  What does this mean?

Health plans that existed before the health care law are considered “grandfathered” and do not have to follow the preventive services cost sharing rules.  This means that the plan can continue to operate as it has until it makes significant changes.

 
Will my plan ever become “un-grandfathered” and have to follow the new rule?

YYes. A recent survey found that 90% of all large U.S. companies expect that their health plans will lose grandfathered status by 2014.  Eventually all plans will lose their grandfathered status and distinctions between the two types of plans will disappear. At that point, all plans will cover contraception without a co-pay.

 
What if I work for a church or another religious employer?

A segment of religious employers, such as churches and other houses of worship, will be exempt from this contraceptive coverage requirement. The Administration also has proposed an “accommodation” for other, undefined non-profit “religious organizations” that allows them to avoid providing contraceptive coverage directly, but ensures that the women who work for them still receive contraceptive coverage without a co-pay. Rules implementing this “accommodation” and the final group of religious employers  who are exempted should be finalized by Aug. 1, 2013.

 
What if I am a student and enrolled in a student health plan?

The new contraceptive coverage requirement applies to student health plans as well, except those that are self-funded.

 
Won’t this make my monthly premiums go up?

While we can’t say for certain, there is strong evidence that covering contraceptives actually produces cost savings, because maternity, infant, and dependent care are more expensive than family planning services. According to the National Business Group on Health (NBGH), a non-profit organization representing employers’ perspectives on national health policy issues, the cost of adding contraceptive coverage without co-pay to a health plan is more than made up for in expected cost savings.  And when contraceptive coverage was added to the federal employee plan, premiums did not increase because there was no resulting health care cost increase.

 
How do I find out if I’m covered?

The first step is to ask your insurer.  Please see our Fact Sheet, “How To Find Out If and When Your Health Plan Will Begin Covering Women’s Preventive Services with No Co-Pay” for guidance about what questions to ask.

 
Who do I call if I think I’m being denied this coverage, have questions or want to share my story?

If you think you have been wrongly denied coverage, you should contact whichever office enforces these laws in your state.  This website from the Federal Government will help you to identify the appropriate agency in your state: http://www.healthcare.gov/using-insurance/managing/consumer-help/index.html

Also, if you think you have been denied coverage, have questions or want to share your story, please call us at 1-866-PILL4US or email us at pill4us@nwlc.org. Our experts here at the National Women’s Law Center are happy to help you in any way that we can.

 

For more information on contraceptive coverage please visit www.nwlc.org/contraceptivecoverage.