New Report Analyzes Health Insurance Coverage of Contraceptives

A new Kaiser Family Foundation report released today finds how health insurance carriers are interpreting and implementing the Affordable Care Act’s contraceptive coverage requirement varies, limiting contraceptive options for some women. The ACA requires most private health insurance plans to cover a range of preventive services for women, including prescribed FDA-approved contraceptives and services without cost sharing. The report reviews how health carriers are applying medical management limitations to contraceptive coverage that affect women’s contraceptive options.

Key findings, drawn from information collected from 20 different health insurance carriers in five states (California, Georgia, Michigan, New Jersey, and Texas), include:

• While many insurance carriers are complying with the spirit of this requirement, the study finds that several carriers require cost sharing, decline coverage, or otherwise limit coverage of certain contraceptive methods, in particular the vaginal ring, the patch and implants.

• Almost all plans cover both a hormonal and non-hormonal IUD. Half of the carriers reviewed cover all three FDA-approved IUDs without coverage limitations or cost sharing. One carrier, however, does not cover ParaGard, which is the only non-hormonal IUD available to women.

• Most carriers cover the progestin-based Plan B emergency contraceptive (EC) pill or its generic equivalents. However, several carriers either do not cover, place coverage limitations, or charge cost-sharing for the ella EC pill, which is a different formulation and does not have a generic equivalent. The ella pill has a longer window of effectiveness than progestin-based EC pills and may be a preferable option for women with higher BMIs.

• Insurers reported they’ve received very few requests for an accommodation from religiously affiliated employers with an objection to some or all contraceptives. Carriers have not identified difficulties in implementing the accommodations that have been requested by employers.

The Kaiser Family Foundation and the Lewin Group conducted interviews with plan officials for nine health insurance carriers and reviewed publicly available plan documents on contraceptive coverage policies for an additional 11 carriers between August and October 2014. The study did not include oral contraceptives because of the large number of different formulations, brands and generics that are available.

The full report, Coverage of Contraceptive Services: A Review of Health Insurance Plans in Five States, is available at KFF.org. Also available soon: an archived web cast of today’s event that includes a presentation of the report’s findings and a panel discussion.

For the latest in women’s health policy, follow Kaiser Family Foundation Vice President Alina Salganicoff on Twitter, @a_salganicoff