April 17, 2015 — While the Affordable Care Act (PL 111-148) has significantly increased access to no-cost contraceptives, some insurers still are not covering all FDA-approved contraceptives without copayments, according to a report released Thursday from the Kaiser Family Foundation and Lewin Group, the Huffington Post reports (Young, Huffington Post, 4/16).
Federal guidance on the contraceptive coverage rules under the ACA states that insurers must cover the full range of FDA-approved contraceptive methods without cost sharing.
However, insurers are permitted to use "reasonable medical management techniques" to curb costs, such as only covering the generic version of an approved contraceptive (Women's Health Policy Report, 2/6). In addition, some plans qualify for an exemption to the rules because they have "grandfathered" status or are for certain religious employers. Court rulings also currently allow some private businesses to deny the benefit (Women's Health Policy Report, 9/19/14).
For the report, researchers from KFF and the Lewin Group conducted a survey of 20 insurers located in California, Georgia, Michigan, New Jersey and Texas.
The report examined "coverage of emergency contraception; hormonal implants; hormonal injections; hormonal patches; the intrauterine device, or IUD; vaginal rings; and sterilization." It did not examine coverage for oral contraceptives, which are the "most popular form" of contraception among those who use birth control, according to Huffington Post.
The researchers found that "[f]or many women, the ACA's contraceptive coverage provision has reduced their health care out-of-pocket costs and given them the opportunity to use more effective but more costly methods of contraception that had been unaffordable to them in the past." However, they added that for some women, "their choice of plan may still result in limitations of their contraceptive options."
For example, the report found that the brand-name vaginal ring NuvaRing was the contraceptive method least likely to be covered by the insurers with no cost sharing. According to the report, five of the 20 insurers only covered NuvaRing with cost sharing, while one did not cover the method.
In addition, researchers found that insurers that did not provide coverage for methods such as hormonal implants, hormonal injections, hormonal patches or vaginal rings said they did not do so because they covered oral contraceptives that deliver the same hormones (Huffington Post, 4/16). However, HHS officials have said that because they are different types of methods, they all must be covered (Women's Health Policy Report, 2/6).
Further, the report found that it was very difficult "to ascertain the limits on contraceptive coverage used by different carriers." The researchers wrote that "[t]he contraceptive coverage policies used by health insurance carriers were not easily accessible" and that such "information is even more opaque in many of the plan materials available to policyholders."
Meanwhile, the researchers also found that many insurers had not established an appeals system for women to gain access to certain methods if they are denied by insurers. Insurers are required to establish such a system under the ACA, according to the Post (Huffington Post, 4/16).
HHS spokesperson Katie Hill said the agency "plan[s] to release more guidance soon" on women's contraceptive access under the ACA, noting, "The [Obama] [a]dministration strongly supports ensuring that women can access contraceptive services as authorized by the women's preventive services provision in the" law (Kliff, Vox, 4/16).
Meanwhile, Planned Parenthood Federation of America President Cecile Richards in a statement said the report demonstrated "that while many women are receiving their birth control without a copay, some insurance companies are not covering the full range [of] methods as required by the" ACA.
She added that Planned Parenthood "encourage[s] the [Obama] administration to provide guidance and clarity to insurance companies to ensure all women can access the birth control methods that work for them without cost barriers, as the law intended" (Planned Parenthood statement, 4/16).