What You Need to Know About Birth Control Coverage

The first thing you should know about birth control coverage is that it may be changing. The Affordable Care Act, approved in 2010, says that insured women will qualify for contraceptives without any out-of-pocket expenses, starting August 2012. However, many details remain to be worked out by insurers, and the future of health care reform could change depending on the outcome of the November 2012 presidential election.

In the meantime, the best thing to do is check with your insurer to see if your coverage has changed—or may soon change—to lower your costs for birth control.

Under the health care law, all contraceptives approved by the U.S. Food and Drug Administration are included among preventive health services available to insured women without deductibles or co-payments. This includes oral contraceptives (the pill), injectable contraceptives, the hormonal ring, contraceptive implants, diaphragms, cervical caps, nonsurgical permanent contraception and surgical sterilization.

But there may be some exceptions, such as for brand-name contraceptives or certain medical costs. Even insurers aren't sure exactly what they must provide or how to do it.

America's Health Insurance Plan (AHIP), an industry lobbying group, sent a list of questions to the Department of Health and Human Services (HHS) in September 2011 asking for details on what types of contraceptives are covered and how insurance policies will work. Here are those questions and the answers AHIP received, as reported by Kaiser Health News:

1. Are male-based contraceptive methods, such as vasectomies or condoms, covered under health reform?

An HHS official responded that women’s preventive services guidelines apply to women only, based on guidelines issued by the Health Resources and Services Administration, part of HHS. AHIP also said in its letter to HHS that insurers are interpreting the rule to include only female-based contraception.

But a senior public policy associate at the Guttmacher Institute, a reproductive health research group, says the language is unclear. Adam Sonfield says it would be foolish to exclude vasectomies, because they are less expensive and pose a lower risk of complications than female surgical sterilization. Also, waiving co-payments for services for one sex but not the other could be challenged as discriminatory, he notes.

2. Are over-the-counter products like female condoms, spermicides and sponges covered by the rules? If so, will they require a prescription, and how will insurers reimburse policyholders for purchases?