So you ring up your birth control prescription at the pharmacy this month and the clerk says, “That will be $0.” Cha-ching. 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, anyway?
The Affordable Care Act has been slowly rolling out requirements for preventive care benefits under 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.) Zero-costcontraception was welcome news to many women.
Under the law, women should have access to the full range of U.S. Food and Drug Administration-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 the 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 Health Underwriters and an insurance broker who works with small employers.
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 being covered.
The clarification states that 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 insurer 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 choices.
Exempt health plans
If your employer is a house of worship, it is formally exempt from the contraceptive coverage of the preventive services provision.
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 values 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.