Gaps in Awareness of Insurance Requirements to Cover Preventive Services Among Women

The Affordable Care Act (ACA) was passed over 14 years ago and yet, there are still gaps in awareness that federal law requires plans to cover the full cost of recommended preventive health care services, especially contraception.

Under the ACA, most private health plans and Medicaid expansion programs must provide coverage with no cost-sharing for many recommended preventive services that are important to women, including female contraceptives, mammograms, and yearly checkup visits. After a decade of major debates over the future of the ACA, today large majorities across partisanship have a favorable opinion of this ACA policy. However, there have been several legal challenges contesting part or all of the ACA, including an ongoing lawsuit, Braidwood Management Inc. v. Becerra, that aims to eliminate the coverage requirement for certain preventive services. While large shares of women ages 18 to 64 (71%) are aware that the ACA’s preventive services requirements cover an annual check-up for women without cost-sharing, nearly three in ten (29%) women either don’t know or believe it does not. Awareness of the benefit is much lower among women ages 18 to 25 compared to women ages 50 to 64 (52% vs. 77%). Knowledge of the requirement to cover routine mammograms is high (73%) among women over the age of 40, but one in four (26%) are not aware (Figure 1).

Even though most women use contraceptives, and plans are required to cover all FDA-approved prescription methods, less than half of reproductive age women (43%) and contraceptive users (47%) know that their insurance should cover the costs in full. Higher shares of Black women are aware of this requirement compared to White women (49% vs. 42%). Notably, less than half (44%) of women with private insurance coverage, for whom this requirement applies, are aware that most insurance plans are required to pay the full cost of birth control for women (Figure 2).

It is possible that some women who are not aware of the contraceptive coverage requirement, have actually paid some out-of-pocket costs for their contraception. There have been a number of reports of people still paying out-of-pocket for their contraception, and recent Congressional investigations have found that some health insurers have continued to charge for contraception that is supposed to be covered in full. In response, the federal government continues to release guidance to clarify and reiterate the requirements for health plans.

Currently, all ACA preventive service requirements are in effect, however, the future is uncertain with legal challenges pending. Furthermore, the lack of knowledge of this benefit may result in fewer women accessing recommended preventive care.