Women's birth control spending has dramatically declined under Obamacare, a new analysis published Tuesday in Health Affairs shows.
Obamacare requires most health insurance plans to cover all contraceptives, including pills, patches, and implants — at no cost to the patient. Under that mandate, women have saved $1.4 billion on birth control pills alone, the Health Affairs paper estimates. Out-of-pocket spending on intrauterine devices, which can cost upward of $1,000, has meanwhile fallen 68 percent.
Under Obamacare, women's birth control spending should fall to zero
Obamacare requires health insurance plans to cover all FDA-approved contraceptives without any cost to the patient.
While birth control is often used as shorthand for hormonal birth control pills, in the case of the health-care law, it actually refers to 18 types of contraceptives that the FDA has found to be safe and effective. This includes but is not limited to oral contraception (a.k.a. the Pill), birth control patches, the ring (otherwise known as Nuvaring), the shot (Depo-Provera), IUDs (intrauterine devices), and permanent contraceptives like sterilization.
The birth control mandate means insurance plans cannot charge co-payments when patients fill any birth control prescription, whether that's for birth control pills, an IUD, or something else.
The Health Affairs paper looks at how that mandate has changed what women spend on contraceptives. It shows that in the six months leading up to the birth control mandate, pill users spent an average of $32.74 per prescription. Afterward, that figure fell to $20.37.
For IUDs, average spending fell even more dramatically, from $262.38 to $84.30.
The real question: Why are women spending any money on birth control at all?
Obamacare's no-cost birth control mandate went into effect in 2012, but the Health Affairs research shows that some women continue to face charges. There are three big reasons why:
- Some insurers weren't complying with the mandate. Two recent investigations — one by the Kaiser Family Foundation and another by the National Women's Law Center — found that some insurers were skirting the rules and using a loophole to continue charging for contraceptives. The White House took steps in May to close that loophole, and you can read more about that here.
- Not every single contraceptive gets covered at no cost. Insurance plans are required to cover every type of FDA-approved contraceptive including pills, patches, and implants. But they aren't required to cover every single option in each category. There are dozens of different birth control pills, for example, and an insurance plan could decide to cover one or two of them. Women who still want the other pills would face charges.
- Some health insurance plans are "grandfathered." Plans that existed prior to Obamacare becoming law back in 2010 are eligible for a "grandfathering" exemption from the birth control mandate, so long as they don't change their benefit package significantly. Insurers generally do like to change benefit packages, though. So over the past five years, the number of grandfathered plans has shrunk, but some of them still exist — and don't have to provide birth control at no cost.
What to do if your birth control isn't free
It's possible that your insurance company is in the right — that the type of pill you want isn't covered under your plan.
That being said, it can never hurt to call and ask: Anyone can challenge an insurance company's coverage decision and find out why a specific type of birth control was denied or came with a co-payment.
The National Women's Law Center is another good resource in this space, offering guidance on how to make sure women get the best access to contraceptives. The nonprofit also offers help to women who are having difficulty accessing no-cost contraceptives. More information is available here.