Last year, a provision was introduced under the Affordable Care Act that mandates all insurance policies cover women’s preventive health services with no copay or coinsurance fees. It’s a big deal. As Cecile Richards, president of Planned Parenthood, told us, “This is a watershed moment.”
But, reading all the small print on insurance policies makes most of us want to pull out our hair, so we’ve sifted through the literature to provide you with some easy-breezy, no-bullshit info on how these laws actually affect you and your access to birth control.
Obama signed the Affordable Care Act in 2010, an insurance mandate that will make healthcare more affordable and accessible to millions. The laws under the ACA are rolling out over four years. This year, enrollment for the Health Insurance Marketplace begins on October 1st. You can sign up for it online. The Marketplace is sort of like an online store where you can look at a whole bunch of health plans and weigh the options, finding the right fit for your needs and budget.
The buzz is that the ACA has created laws that insurance policies must now include tons of cost-free preventive care like health screenings and women’s contraceptive services.
When does this Marketplace exchange coverage start?
Coverage under a Marketplace plan begins January 1, 2014 and you can enroll in the exchange between October 1 and March 31, 2014. If you’re considering it, you might want to act early; when your health care coverage will begin depends on how soon you enroll.
What are the plans in the new exchange going to cost me?
While none of the costs will be officially released until October, to get a sense of what your premiums might be through the new Marketplace, the Kaiser Family Foundation has created a helpful calculator.
Who’s going to benefit from this preventive-care-good-time fiesta?
Millions of people, but namely, women! The historical cost disparity between women and men’s insurance has been ludicrous, with insurance companies “gender rating” based on the higher costs of women’s preventive services. As of 2012, 90% of the best selling health plans still charged women more than men.
Starting in 2014, gender rating, amongst other discriminatory insurance practices will be banned. Woo-hoo. Estimates show approximately 47 million women could benefit from preventive health care coverage under the Affordable Care Act, once the plans rolls out.
What kinds of preventive services for women are we talking about?
22 types of preventive services — though not every single preventative service you may require — are provided without copayment or coinsurance under the ACA for all new and non-grandfathered private insurance plans as of August 1, 2012. We’ll only be talking about the contraceptive mandate in detail in this article, so here's a full and detailed list of what is covered. These services include breast cancer screenings, well woman visits, and, of course, contraception!
I love the sound of free preventive services — especially BC, but does my plan cover this?
If you buy your insurance through the Marketplace exchange after October 1st: Yes, definitely. Even if you haven’t met your yearly deductible, the ACA protects your right to all 22 preventive services without co-payment, provided that you get them through a doctor that takes your specific insurance. When you’re selecting a plan, ask for a list of health care providers in your area to make sure you’re not signing up for something without adequate or nearby doctors.
If you already have an insurance plan (including student plans), you could already have these benefits without cost sharing. If you’re not sure if they have kicked in for you, ask your insurance provider. Just flip over your card and find a number to call.
However, if you bought a plan that was started or was created before March 23, 2010, that makes your plan what they call “grandfathered in.” (Think: a stuffy old grandfather who won’t change his ways, despite how unmodern they seem.)
For grandfathered plans, the rights and benefits granted under the ACA might not be granted to you. Check your plan’s materials or ask your employer if your plan’s status affects your ability to get free preventive services.
The birth control mandate also doesn’t apply to plans sponsored by certain exempt non-profit or religiously-affiliated employers. We’ll get into the nitty gritty of that later.
Not exactly. You still have to pay a monthly premium and a yearly deductible for your health care plan under the ACA. So, unlike some opponents’ claims that the government is giving out birth control for free, willy-nilly, women will still technically pay for their contraceptives in the long run. There just won’t be out-of-pocket costs with every trip to the pharmacy.
You said no co-pays or co-insurances on all forms of contraceptives, but there’s got to be a catch. How does the ACA define contraceptives?
The pill, injectables, the ring, contraceptive implants, IUDs, diaphragms, cervical caps, and non-surgical permanent contraceptives. Note that this does not include abortifacient drugs — like "The Abortion Pill" — but does include emergency contraception. And, possibly the coolest part of all of this is that all services related to contraception — follow-ups, side effect management, and device removal — are included in this coverage.
But — super-important — this law only requires that ONE of EACH kind of FDA-approved contraceptives be covered. This means the generic will be provided for each kind of method without cost sharing, but brand name drugs might not be covered. Check to see if your brand is being covered when you check if your insurance covers the mandate.
Is Planned Parenthood going to take coverage provided from the new Marketplace exchange?
Cecile Richards, President of Planned Parenthood told us, “Some plans will include Planned Parenthood and some will not. If you want to come to Planned Parenthood or have us as option with your new insurance, it’s important to make sure that you choose a plan from the marketplace that includes us. Planned Parenthood will provide a tool on our website where visitors can type in their zip code and then find out which insurance plans include Planned Parenthood as a provider.”
Are there any employers who don’t have to provide cost-free contraceptive services in their healthcare plans?
Yes! The birth control mandate does not apply to health plans sponsored by certain exempt “religious employers.”
Don’t worry; it’s not the end of the world. During the safe harbor period, the government put laws on the books to provide women in these religiously exempt plans with alternative methods to obtain contraceptive coverage. So, who’s actually paying for the care?
Judy Waxman of the National Women’s Law Center told me, “The women with religious employers will get [contraceptive services] the same way as if they worked for anyone else. It’s all behind the scenes. Let’s say I’m a religiously-affiliated school, all I have to do is certify to my insurance company that I am a religiously-affiliated school and I don’t want to have to cover the contraceptives. The insurance company will then have to do it themselves. The school isn’t paying for it, the insurance is.”
If that “alternative method” doesn’t work and if your particular birth control method or other preventive service is not being covered, then call the National Women’s Law Center at 1-866-PILL4US. While she didn’t have any statistics, Waxman said the NWLC has a pretty good success rate with educating women about their rights and getting them the aid they need.
Are there any other unexpected ways my right to birth control without cost sharing could be obstructed?
Not to give you a headache, but yes, there are other loopholes that could make your path to cost-free contraceptives a little bit trickier. But they have nothing to do with your insurance. In some states, doctors and pharmacists can refuse to provide contraceptive services to you if they object to providing that care for personal or religious reasons.
Why is this birth control mandate so important?
Cecile Richards, President of Planned Parenthood Federation of America, says it best: “This isn’t just a health care issue – it’s a fundamental economic issue for women and their families. More than a third of women voters say they’ve struggled to afford their birth control prescription at some point in their lives – and because of that, they haven’t used it consistently. But, studies show that when cost isn’t a factor, women switch to the birth control method that’s right for them – and experience fewer unintended pregnancies. Access to birth control has made it possible for generations of women to plan their families – get an education – and pursue their dreams.”