Contraception is legally free. 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 birth control, a move that thrust access to contraception back into 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 were also rejecting appeals from consumers seeking coverage for their contraceptives. Some experts estimate that these practices could have seriously damaged access to contraception for millions of women.
Since 2012, the Affordable Care Act has required private insurance plans to cover the following costs: “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.
That means consumers shouldn’t have to pay any co-pays with in-network providers, even if they haven’t met their deductible. Some plans may cover only generic versions of certain contraceptives, but patients are still entitled to coverage for a specific product that their providers deem medically necessary. Medicaid plans have a similar provision; the only exception to the mandate is 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 KFFa nonprofit health policy research organization, which found that about 25 percent of women with private insurance reported that they paid at least some of the cost of their contraceptives; 16 percent reported that their insurance provided partial coverage, and 6 percent reported that their plans did not cover contraceptives at all. Additionally, a 2022 congressional surveywhich analyzed 68 health insurance plans, found that the process of requesting exemptions and getting contraceptive coverage was “burdensome” for consumers, with insurance companies rejecting an average of at least 40 percent of exemption requests.
In a letter to Congress earlier this year, AHIP, a national advocacy group that represents 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 minor,” said Anna Bahr, communications director for Sen. Sanders. Each time a company is penalized, 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 did not cover hormonal rings, intrauterine devices or patches because they covered another hormonal method: the birth control pill. The practice violated the mandate and prompted the Obama administration to crack down.
Today, consumer complaints are a little 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, in which patients are required to try specific products, usually oral contraceptive pills, until they “fail” before they can get the birth control option they want and that their health care provider recommends.
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 are charged for contraception
Talk to your doctor and your insurance company and remind them that the law says you don’t have to pay, Ms. Salganicoff says.
You can also call the National Women’s Law Center Helplinewho will help you take a thorough 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.
Consumer complaints in Vermont led to a two-year investigation into health insurance companies there, which found that nearly 9,000 people had been wrongly billed for contraceptives. As a result, the state ordered insurance companies to Last year $1.5 million in refunds.
“Public pressure helps enormously,” said Ms Borchelt.
