As the Affordable Care Act (ACA) has been rolled out over the last year and a half, there have been some controversies on certain coverage rules. As an example, a report from the Kaiser Family Foundation (KFF) showed that insurers were very inconsistent with the birth control coverage they offered.
Although the ACA requires birth control to be offered without any cost-sharing – copayment or deductible – required, some insurers were only partially complying. They would offer specific methods, but require copayments for others, or would only offer generic without charge and would require payment for name-brands. Clarification and enforcement was clearly needed.
Clarifications on Birth Control
Because of the confusion, the Obama administration offered clarification as to what the law requires. In guidance released on May 11, 2015, the administration spelled out several details.
In particular, the statement clarified that insurance plans must cover, at no cost to the patient, at least one product in each of the 18 FDA-approved contraceptive method categories. Within each category, insurers can use reasonable medical management techniques to reduce costs, such as offering generics free of charge but requiring cost-sharing for name brands.
There is a major exception, however. If a woman’s medical provider indicates that the name brand or other type of contraception is medically needed, the insurer must have a mechanism for waiving the fees and providing the product or service with no charge to the patient.
What This Means for Consumers
As a consumer, you have a right to receive the required protections under the ACA. With this new guidance from the Obama administration, it is much clearer what you can expect from your insurer. The Kaiser Family Foundation put together a great chart that can help you understand the details of the latest clarification.
If you feel that your rights regarding contraception are being violated by your insurance company, file an appeal with your insurer on any denial of coverage or cost-sharing billing you receive. If that does not resolve the issue, you can report the insurance company to your state’s Department of Insurance. You can also contact women’s advocacy groups for advice and help.
This guidance applies to insurance plan years beginning on or after July 10, 2015. You may need to check with your insurer to determine when your plan year begins in order to understand when this new guidance will apply to your insurance.
Making sure that you receive the treatment and protections you deserve is partly your responsibility. By being educated on the unfolding application and enforcement of the ACA, you can make sure you protect your own rights regarding your medical care.
For more information related to women’s health coverage, read Women’s Health Insurance Coverage & Concerns Under the ACA.