The Affordable Care Act (ACA) has provided coverage for more than 55 million women for preventive services without any cost sharing for contraceptive services and supplies. However, despite the expanded coverage, millions of women still face barriers as they try to access their new benefits. (Read part 1
Barriers remain, despite gains
Despite the ACA’s focus on making many forms of contraceptive coverage available without any cost sharing under most health plans, important administrative and legal barriers remain.
The contraceptive guarantee doesn’t, for instance, cover emergency contraception obtained without a prescription, and it excludes male contraceptive methods, such as vasectomy and condoms.
Plans also can make ACA-mandated contraception harder to access by requiring some services to be obtained from in-network providers, or by imposing higher copays and deductibles for out-of-network services.
Grandfathered plans are exempt from the certain contraceptive coverage requirements (until the plan changes significantly enough to no longer be considered grandfathered). To be grandfathered, a group plan must have existed – or an individual plan must have been sold – before President Obama signed the ACA on March 23, 2010.
Although, it is projected that nearly all grandfathered plans will eventually lose that status, in 2015, 35% of companies offering health benefits offered at least one grandfathered plan—and 25% of covered workers were enrolled in grandfathered plans, according to the Kaiser Family Foundation.
In addition, some religious employers’ health plans may also be partially or wholly exempt from the contraceptive coverage after suing to be exempt from the mandate. In 2014, the Supreme Court ruled that some closely held corporations had a right to an exemption from the mandate. After that decision, the Obama administration announced a workaround “to make sure all women continue to have access to all methods of birth control with no cost sharing, no matter where they work, while respecting others’ religious beliefs.”
Bypassing the barriers to access
To avoid some of these pitfalls, consumers will need to do a little legwork, starting with confirming that their contraceptive of choice is covered on a prospective insurance policy. They also should seek contraceptive counseling from a clinician in their plan’s network, said Mary C. Politi, PhD, an associate professor in the Division of Public Health Sciences at Washington University School of Medicine in St. Louis.
“Contraceptive counseling can ensure that individuals select a method that works for them and matches their personal preferences,” said Politi, who authored a contraceptive opinion piece published in the February 16, 2016, issue of JAMA.
“Clinicians and patients should work together to address some of the implementation challenges related to billing and covered contraceptive methods,” she added. “They can talk about methods that are covered by one’s plan, talk about less expensive alternatives if some methods are not covered, and communicate openly about whether any out-of-pocket costs will fall on patients.”
Read part 3