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Insured Women Increasingly Pay Nothing Out of Pocket for Contraceptives, Guttmacher Survey Finds

Insured Women Increasingly Pay Nothing Out of Pocket for Contraceptives, Guttmacher Survey Finds

September 19, 2014 — Sixty-seven percent of U.S. women with private health coverage paid no out-of-pocket costs for oral contraceptives this spring, compared with 15% of women in fall 2012, before the Affordable Care Act's (PL 111-148) contraceptive coverage benefits took effect, according to a new Guttmacher Institute study, the Seattle Times' "Healthcare Checkup" reports.

The proportion of insured women who paid nothing out of pocket also rose substantially for other methods, like the vaginal ring and intrauterine device, the study found (Stiffler, "Healthcare Checkup," Seattle Times, 9/18).

Background on Contraceptive Coverage Benefit

Federal guidance on the contraceptive coverage rules under the ACA states that insurers must cover the full range of FDA-approved methods without cost sharing.

In addition, some plans qualify for an exemption to the rules because they have "grandfathered" status or are for certain religious employers (Women's Health Policy Report, 8/22). Court rulings also currently allow some private businesses to deny the benefits (Women's Health Policy Report, 9/18).

Study Details

For the study, Guttmacher researchers conducted an online survey of U.S. women ages 18 to 39 who responded to questions four times over an 18-month period. The women all had private insurance and were using prescription contraceptives.

This spring, 74% of women paid no out-of-pocket costs for the vaginal ring, compared with 20% in fall 2012, while 59% of women paid nothing out-of-pocket for injectable contraceptives this spring, up from 27% in fall 2012. Further, 62% of women paid no out-of-pocket costs for IUDs in spring 2014, compared with 45% in fall 2012.

Reasons for Findings

The researchers outlined several reasons why some privately insured women were still paying out-of-pocket costs for FDA-approved contraceptives this spring, including the grandfathered status of some health plans, insurers being permitted to charge copayments for brand-name contraceptives when generic versions are available in some cases, and exemptions for employer-sponsored plans on religious grounds.

Further, the researchers said some insurers also are improperly imposing cost-sharing requirements on women for contraceptives that should be covered, as Guttmacher has previously found.

Researchers: Coverage 'Working as Intended'

The researchers wrote, "By guaranteeing that women have coverage for a wide range of contraceptive choices without cost sharing, the federal requirement may help them overcome financial barriers to choosing a contraceptive method they will be able to use consistently and effectively, thus increasing their likelihood of avoiding unplanned pregnancies."

Adam Sonfield -- lead study author and senior public policy associate at Guttmacher -- added in a statement that the study "shows that the contraceptive coverage guarantee under the ACA is working as intended" ("Healthcare Checkup," Seattle Times, 9/18).