So you ring up your birth control prescription at the pharmacy
this month and the clerk says "that will be $0."
You can't beat that price.
But unfortunately the more common scenario is that the clerk
asks for the $10, $20, or $35 co-pay they've asked for every month.
What happened to the "free preventive care services," including
contraception, that were promised under the Affordable Care Act,
The Affordable Care Act has been slowly rolling in
requirements for preventive-care benefits
in which most insurance plans must cover and eliminate cost-sharing
for recommended preventive health services, including
contraception. (Health plans that are "grandfathered" in don't have
to comply yet.)
contraception was welcome news to many women.
Under the law, women should have access to the full range of
FDA-approved contraceptive methods at zero cost, as well as patient
education and counseling. This includes, but is not limited to, a
range of pills, the ring, the patch, the shot, implants, hormonal
intrauterine devices, non-hormonal intrauterine devices, barrier
methods and sterilization procedures.
But when it comes to free-contraception benefit, there has been
some confusion. It turns out there are different dates for when the
contraceptive benefit becomes available.
For some plans it went into effect Aug. 12, 2012. Grandfathered
health plans can wait until 2014.
"Groups that were grandfathered, which meant they had policies
in place at the time the law went into effect and they haven't
changed at all in terms of deductibles and co-pays, are exempt from
adding the preventive coverage until January 2014," says Lynda
Feder, treasurer of the New Jersey Association of Heath
Underwriters (NJAHU) and an insurance broker who works with small
What contraceptives are covered?
There's also confusion about which contraceptives will actually
be free. The Affordable Care Act says "all FDA-approved
contraception as prescribed" should be covered. However, many women
are finding that their insurers cover only a few contraceptive
choices, or cover only generic prescriptions, or haven't renewed
the policies yet and so the benefit hasn't kicked in.
Recently the government came out with a clarification because
some health plans were covering only one method, explains Alina
Salganicoff, vice president and director of women's health policy
for the Kaiser Family Foundation. For example, Salganicoff has
heard about many instances of Nuva Ring, a hormonal device, not
The clarification states if there is a generic alternative, it
is to be offered, but if the woman and her provider decide there is
not a good generic equivalent, the
company must honor that. And if there is no generic equivalent, the
plan must cover the brand-name contraceptive.
"People need to be aware of this and contact their insurance
company and let them know that there has been a clarification in
the policy," says Salganicoff, especially if their insurer says it
only offers generics or only offers one or two contraception
Exempt health plans
If your employer is a house of worship, it is formally exempt
from the contraceptive coverage of the preventive services
To qualify for exemption, a house of worship must be a nonprofit
that primarily employs and serves people who share its religious
tenets and primarily teaches religious value as its purpose.
If your employer is a religiously affiliated nonprofit
organization like a hospital or a charity, it has a "safe harbor"
in which to self-declare it will not participate in the
contraceptive portion of preventive services. The safe harbor
deadline is August 2013.
The government is in the process of creating guidelines for
employers that have a religious objection to contraception.
Proposed guidelines state that employers that buy insurance through
an insurance carrier will have that carrier cover the cost of
contraception. The reasoning is that if women prevent pregnancy it
will save the insurer money downstream.
For employers that self-insure, the proposed guidelines ask that
a third-party administrator provide a contraceptive-only plan.
These guidelines will affect only nonprofit employers that
object to covering contraception for religious reasons. Currently
the government is soliciting feedback for the proposed guidelines
from providers, insurers and the general public.
For-profit businesses must comply.