Contraception is free by law. So why do a quarter of women still pay for it?
Last week, Sen. Bernie Sanders of Vermont, chairman of the Senate Health Committee, called on a government watchdog to investigate why insurance companies continue to charge women for contraception — a move that put access to contraceptives back in the spotlight.
In a letter to the Government Accountability Officethe senator noted that insurance companies were charging Americans for contraceptives that should be free under federal law — and that they were also denying appeals from consumers seeking reimbursement for their contraceptives. Some experts estimate that these practices may reduce access to contraception millions of women.
Since 2012, the Affordable Care Act has required private insurance plans to cover the disease “Full-range” female contraceptives approved by Food and Drug Administrationincluding female sterilizations, emergency contraception, and any new products approved by the FDA. The mandate also includes contraceptive-related services, such as counseling, insertion or removal of contraceptives, and follow-up care.
This means that consumers are not allowed to pay co-payments to in-network providers, even if they have not met their deductible. Some plans may only cover generic versions of certain contraceptives, but patients are still entitled to coverage of a specific product that their providers deem medically necessary. Medicaid plans have a similar provision; the only exception to the mandate are plans sponsored by employers or colleges that have religious or moral objections.
However, many insurers still charge for contraceptives. Some insurers ask for a co-payment, others refuse to reimburse the costs completely.
A quarter of women pay unnecessarily for contraceptives
In his letter, Senator Sanders quoted a recent study by KFF, a nonprofit health policy research organization, which found that about 25 percent of women with private insurance plans said they had paid at least part of the cost of their contraception; 16 percent reported that their insurance plans provided partial coverage, and 6 percent noted that their plans did not cover contraceptives at all. Additionally, a 2022 congressional surveythat analyzed 68 health plans found that the process of requesting exceptions and getting contraceptive coverage was “burdensome” for consumers and that insurance companies denied an average of at least 40 percent of exception requests.
In a letter to Congress earlier this year, AHIP, a national lobbying group representing insurance companies, noted that the group “will continue to work with the Administration, Congress, and policymakers to ensure that consumers have affordable access to contraception in accordance with the law.”
Despite the fact that the federal mandate has been in place for more than a decade, companies continue to skirt the law because “these mandates are rarely enforced and the penalties for ignoring them are relatively low,” said Anna Bahr, director of communications for Senator Sanders. Every time a company is punished, it finds other ways to deny coverage, she said.
In 2015, a study of the The National Women’s Law Center, a nonprofit legal organization, found that several insurance companies claimed they would not cover hormonal rings, IUDs or patches because they did cover another hormonal method: the birth control pill. This practice violated the mandate and prompted the Obama administration to crack down.
Today, consumer complaints are slightly different, said Gretchen Borchelt, vice president of reproductive rights and health at the law center. The group has heard from women whose plans have a “try and fail” caveat, where patients are expected to try specific products, usually oral contraceptive pills, until they “fail” before they can get the contraceptive option they want and who their healthcare provider recommends them.
Earlier this year, the Department of Labor, one of three government agencies responsible for enforcing the Affordable Care Act mandate, called out the practice “problematic.”
Insurance companies also often deny coverage for newer FDA-approved contraceptives, said Alina Salganicoff, senior vice president and director of women’s health policy at KFF. The organization has also found that companies may cover a contraceptive product, such as an IUD, but deny associated services, such as insertion or removal, she said. According to a study published last summer, the share of privately insured women who paid nothing for their IUDs or implants declining since 2015.
What to do if you have to pay for contraception
Talk to both your doctor and your insurance company and remind them that the law says you don’t have to pay, Ms. Salganicoff said.
You can also call the Hotline of the National Women’s Law Centerwhich will help you take a hard look at your plan to figure out what the problem is, Ms. Borchelt said. Sometimes the hotline can help patients get reimbursements.
Consumers should also let their representatives know, she said, because such complaints can often be investigated.
Complaints from consumers in Vermont led to a two-year investigation into health insurance plans there, which found that nearly 9,000 people had been incorrectly billed for contraceptives. As a result, the state ordered insurance companies to $1.5 million in refunds last year.
“Public pressure helps a lot,” Ms. Borchelt said.
