Something About No Co-pays

by Adrianna McIntyre

hi so something about no co-pays anymore? when does that kick in? blinked my Gchat yesterday afternoon. If you missed the headlines, the Affordable Care Act requirement that insurance companies cover contraceptives without cost-sharing (the co-payment you usually pay when picking up a prescription) went into effect yesterday. Well, kind of. “Into effect” is something of a dubious legal term. Here’s some clarification on what’s going down:

So, can I go get birth control without a co-pay today? 

Wait a hot second before you go scheduling that gyno appointment. The short answer is frustrating: It depends.

  • The new provisions go into effect immediately for plans that are new or renewed as of yesterday, August 1. This is good news for college students who start a university health plan this fall: you should be covered once that plan starts.
  • For some people currently on a private insurance plan, the contraceptive mandate will go into effect at the start of the next insurance plan year, when your plan renews. Many follow the calendar year, so for these plans January 1 is likely the day the provision will kick in.
  • That is, unless your plan is considered “grandfathered.” If your insurance plan was in effect on or before March 23, 2010, it might be considered grandfathered, and can delay implementation of some ACA provisions. For these plans, the provisions won’t kick in until the beginning of 2014.
  • All of that stuff only applies to people who already have insurance–but that’s not to say that women without coverage are bang out of luck. Short-term, your local Planned Parenthood could be a valuable resource. You should also pop by to see what kinds of insurance you might qualify for.

A little more fine print: if you take brand-name birth control, like Yaz or Ortho Tri-Cyclen, when a generic version is available for that brand, a co-pay may still be expected. Not sure if your pill is considered brand-name? This list might be useful.

The best way to know for certain when you’ll be covered is to chat with your insurance’s customer service reps. The National Women’s Law Center has put together a handy guide on what to say once you get through to a real person.

Remind me again, what all gets covered?

If I’ve been at all coherent so far, you know that insurance companies are/will be required to pay for contraceptives–and not just the pill, but IUDs, the birth control shot, and sterilization, too. But wait, there’s more! Also effective yesterday (or whatever future date “in effect” applies to you and yours), there are six other preventive services that insurance companies must offer female clients at no cost. Additionally, the ACA requires that insurers cover a host of general preventive services for all adults and children. You can check out the full list here.

Anything else I should know?

Churches are exempt from the contraceptive coverage requirement, though they still have to cover the other preventive services we mentioned. There have been ongoing legal scuffles between the Administration and religiously-affiliated organizations (like schools, hospitals, charities… and apparently air-conditioning companies). Recently, a federal court ruled for the first time against the contraceptive mandate, allowing Hercules Industries, a Colorado-based air conditioning company, to refuse compliance with the provision for at least three months based on the first amendment rights of the owners. The judge specified that this ruling is a temporary injunction while the merits of the case are decided, and that it only applied to the company who brought the case. Twelve lawsuits filed by Catholic organizations in 43 different courts are still pending, so stay tuned.

If you have any other questions, leave them in the comments!

photo credit:

Adrianna works in clinical research and will begin graduate studies at the University of Michigan this fall.
Follow her on Twitter @onceuponA.


2 thoughts on “Something About No Co-pays

  1. Shana says:

    What about Nuva Ring? Will that be covered?

    • That is an excellent question, and one I’m having a difficult time finding a solid answer for. Exact covered contraceptives are going to vary from insurance to insurance. The closest I’ve come to finding a “list” of covered contraceptives is this update from United Healthcare (see the Member FAQ PDFs). UHC is one of the nation’s largest insurers, so I think it should be a fairly representative guide.

      Unfortunately, NuvaRing isn’t on either list. At this time, there isn’t a generic version, which may be a factor at play. I’m a little bit perplexed by this, as the HHS website describes the mandate as applying to “”all Food and Drug Administration approved contraceptive methods…” [emphasis added], and I would personally consider NuvaRing a different method than oral contraceptives. However, they may be considered under the same class for policy purposes–it’s possible that the FDA is breaking down the classifications into categories like “hormonal contraceptives” and “barrier contraceptives,” or something to that effect.

      That isn’t to say that this is a zero-sum game–if it isn’t $0-copay, that doesn’t mean that insurers will suddenly demand the sticker price for NuvaRing (or other) prescriptions. The best way to know if copay will change for you in the future is to call your insurance provider and ask a) when you’re eligible for $0-copay contraceptives, and b) whether copays for your particular prescription will be subject to any changes.

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