Tips From the Hotline: Help! I'm Still Paying for My Birth Control — What Gives?

Tips From the Hotline: Help! I’m Still Paying for My Birth Control — What Gives?

Thanks to the federal health care law, known as the Affordable Care Act or ACA, most health insurance plans are covering birth control without out-of-pocket costs. So why isn’t yours? We’re here to answer your questions.

You’ve heard that birth control was supposed to be covered by health insurance because of the ACA, and it seems like everyone and their mom has been getting birth control without copays, except you. You’re still being charged a $10-$30 copay every time you pick up your birth control. So why isn’t your birth control covered like everyone else’s yet?

Grandfathered vs. Ungrandfathered

You might have heard these terms already if you’ve tried to find out why you’re still being charged for birth control. A “grandfathered” plan is a health plan that existed before the ACA was enacted. In 2015, about a quarter of all U.S. workers with coverage through an employer are still in grandfathered plans. These plans do not have to follow the birth control coverage requirement yet. This means the plan can still play by the “old rules” (pre-ACA) when it comes to coverage of birth control and other preventive services. They can charge copays, deductibles, or coinsurance, and choose to cover some birth control methods and not others. This can affect your well-woman visits too, which means you might still have a copay when you go for a check-up.

An “ungrandfathered” plan, on the other hand, is one that is new or has changed significantly since the ACA was enacted. If you have one of these employer plans, the ACA has kicked in for your plan, and it should be covering birth control and other preventive services without out-of-pocket costs. And, if you bought your plan in the health insurance marketplace or bought it on your own after March 23, 2010, your plan should be covering preventive services without out-of-pocket costs as well.

How do I find out about grandfathering?

The best way to find out if your plan is grandfathered is to call your plan and ask. Sometimes your employer can help with this too. This flowchart on our website can help you ask your insurer the right questions to find out if your plan is grandfathered. Your plan has to let you know if they are grandfathered, either in the documents you get when you sign up for coverage or when you call. If the customer service person on the other end cannot tell you if they are grandfathered, keep asking and ask to speak to a supervisor if you aren’t getting answers.

Will my plan ever be ungrandfathered?

Yes! The good news is that all employer health plans will eventually become ungrandfathered. Oftentimes, plans become ungrandfathered when a new plan year starts, which for most plans happens on January 1. So, the beginning of the year is always a great time to check on your plan’s status. Your employer might also be able to tell you when the health coverage they offer will be ungrandfathered. Once your plan becomes ungrandfathered, it should be providing coverage without out-of-pocket costs for birth control and other preventive health services.

My plan is ungrandfathered, but I still don’t have coverage of birth control without cost-sharing?