The Affordable Care Act and Contraceptive Benefits

Navigating the world of health insurance in the United States is no easy task, especially when it comes to birth control. While the Affordable Care Act (Obamacare) guarantees coverage for most women with health insurance, the details can vary from state to state and plan to plan.

The Affordable Care Act

Under the Affordable Care Act (ACA), insurance companies are required to cover all prescription birth control options for women. You can get this prescription birth control without having to pay a copay at the pharmacy–even if you haven't yet reached your deductible.

These federal guidelines apply to almost all types of insurance. This includes:

• Private insurance plans (from your employer)
• Private plans purchased on the Health Insurance Marketplace
• Medicaid (public health plans from states)

There are a few exceptions, however. According to the ACA and subsequent legal actions from the courts and state legislatures, certain religious entities are exempt from the federal birth control guidelines. Under the Trump administration, this was expanded to entities with a "moral" objection to contraception.

This means that some employers may not be required to provide their employees with an insurance plan that covers birth control. Employers that seek these exemptions are predominantly religiously-affiliated organizations, such as:

• Schools and universities
• Hospitals
• Churches
• Nursing homes
• Charities and non-profit organizations

Of course, not all religiously affiliated organizations seek exemptions. Most do not. Fewer still have met the requirements for exemption, as these things are often tied up in the courts. The employees of some of these organizations can still receive birth control coverage through state and federal workarounds, at no extra cost.

Covered Birth Control Methods

The ACA guarantees that your insurance plan will cover all types of prescription birth control for women. This includes:

• Birth control pill
• IUD (intrauterine device)
• Birth control implant
• Birth control shot
• Birth control patch
• Vaginal ring
• Diaphragm
• Cervical cap
• Birth control sponge
• Internal (female) condom
• Tubal ligation (getting your "tubes tied")
• Fertility awareness counseling
• Emergency contraception (the morning-after pill)

Since there are so many brands of birth control pills, your health insurance company may only cover some of them. If your contraceptive has a generic version, your insurance plan can choose to only offer the generic alternative for free.

If your healthcare provider determines that the name-brand drug is medically necessary for you, then your insurance company must provide a waiver process that will allow you to get it without a copay. This may require a prior authorization form from your healthcare provider.

Other Covered Services

Medical appointments related to contraceptives must also be covered, typically with no copay. This includes appointments for:

• Inserting and removing an IUD
• Inserting and removing an implant
• Birth control shots
• Surgical consultations
• Annual gynecological visits
• Emergency contraception
• Family planning/contraceptive counseling

Over-the-counter female contraceptives such as spermicides, female condoms, the sponge, and emergency contraception are covered in some states. You can always purchase these methods normally at a pharmacy–as you do with regular condoms–or you can try to get them covered.

Typically, if you want to get an OTC option covered by insurance, you will need a prescription from a healthcare provider. When your healthcare provider sends a prescription to the pharmacy, you can pick these up like any other prescription.

In some states, a pharmacist can prescribe and distribute certain birth control options, like birth control pills and emergency contraception. In these cases, you should be able to get full coverage.

What's Not Covered

Regular, male condoms are not covered by most insurance plans. However, if you are looking for free condoms, you can typically find them at local health clinics like Planned Parenthood.

Vasectomies are included in many health plans, but the ACA doesn't require insurance companies to cover them. Check out your insurance company's website for more information. Many plans cover part or all of the charge.

Abortion services, including the abortion pill, are not guaranteed by the ACA. Some insurance companies cover the full cost of abortion or part of the cost. Some state Medicaid programs also cover all or part of abortion costs. Other insurance companies do not cover them at all.

There are other resources you can turn to if your insurance company doesn't cover the cost of an abortion. Contact your local Planned Parenthood to learn more about financial assistance.