What You Need to Know About Birth Control Coverage

Over-the-counter contraceptives will be covered without cost sharing when they are prescribed by doctors, the HHS official said. But advocates and insurers are not sure how this will work. Insurers caution that requiring prescriptions for over-the-counter contraceptives could increase the burden on already overburdened primary care providers and drive up costs. Setting up systems to track the costs and reimburse women for these products could prove more costly than the products themselves, the insurers contend.

Because of those potential costs and inconveniences to women, prescriptions should not be required for over-the-counter contraceptives, says Judith Lichtman, senior advisor to the National Partnership for Women and Families, an advocacy group in Washington, DC.

3. If a hospital stay is required for surgical procedures, such as for female sterilization, would the procedure be covered without cost sharing?

HHS has not answered this question yet, and insurers remain uncertain whether hospitalization or complications that might occur from surgery would be covered without a patient co-pay or deductible.

4. Will insurers be required to cover all products in a class, such as all IUDs or all birth control pills? Can insurers require a co-pay for a brand-name drug if a generic is available?

The HHS says that insurers may continue to offer "tiered" pharmacy benefits. Under this structure, patients pay differing amounts for brand-name products, as opposed to generics. Some insurers require patients who choose a brand-name drug over an equivalent generic to pay the price difference between the two. The insurers say HHS guidance allows them to use such "reasonable medical management" to help control costs.

The HHS confirmed that charges for brand name drugs would be allowed, but stressed that plans must "accommodate any individuals for whom it would be medically inappropriate by having a mechanism for waiving the otherwise applicable cost-sharing for the branded version."

5. Who will be covered for contraceptives without co-payments?

Health reform requires that the package of women’s preventive care benefits must be offered in all new insurance policies sold to individuals and employers starting Aug. 1, 2012. Many existing policies will include the benefits on the date that they renew after Aug. 1, which for many companies will be Jan. 1, 2013. Health plans that existed before health reform passed in 2010 may be "grandfathered," but most must comply by 2014. Some nonprofit religious employers who object to birth control are exempt from providing coverage for contraceptives.

If you use birth control or are considering using or changing birth control, talk to your health care professional and your insurance company to find out what kind of birth control coverage is available. And keep in mind that coverage may change as details are ironed out or the health reform act itself is changed.

If you think you have been denied coverage for which you are eligible, contact the state office that enforces these laws where you live. This federal website will help you identify the appropriate agency: http://www.healthcare.gov/using-insurance/managing/consumer-help/index.html