Q. Under the Affordable Care Act (ACA), health insurance plans are required to provide all forms of birth control free of charge. Is that rule still in effect?
A. Yes, but with a big, new exception that affects women whose employers have a religious or moral objection to contraception.
The backstory: Under the ACA, birth control is considered a preventive service that insurers must pay for in full, with no out-of-pocket costs to the consumer. With the exception of a few grandfathered plans held over from pre-ACA days, insurers have to cover at least one each of 18 types of birth control. As a consequence, only 3 percent of insured women report having to spend their own money on birth control, compared with about 20 percent previously.
From the beginning of the ACA, the government allowed churches that objected to birth control to obtain an exemption from this rule, meaning their employees had to pay for birth control out of their own pocket.
Religiously affiliated nonprofit employers, such as schools and hospitals, could opt for an “accommodation” so that they didn’t have to pay for contraception. But their employees could still get it free because insurers paid for it directly. The Kaiser Family Foundation estimates that as of 2015, about 10 percent of nonprofits with 5,000 or more employees had gotten this accommodation.
In October of 2017, the government issued new regulations — effective immediately on an “emergency” basis — that vastly expand the types of employers who can obtain an exemption. It’s now available to any nonprofit or for-profit employer with a “religious” or “moral” objection to contraception.
“It’s a sweeping and broad expansion of the exemption,” says Mara Gandal-Powers, senior counsel of the National Women’s Law Center, a public interest group based in Washington, D.C. “If your employer gets the exemption, your birth control would be entirely out of pocket.”
Q. How many health plans are affected and how will I know if mine is one of them?
A. Too soon to tell, as the regulations require employers to give at least 60 days’ notice to affected employees. “Pay attention to any insurance notice you get from your insurance company,” advises Gandal-Powers. “The law requires insurers to tell you that the coverage is going away.”
Q. I buy insurance on my own, not through an employer. Will I be affected?
A. No. Those plans will continue to cover birth control with no out-of-pocket cost to you. That’s true whether you buy your health insurance on or off a state exchange.
Q. What’s to stop all employers from saying they have a moral objection so they don’t have to pay for birth control?
A. In theory, nothing. “But if you don’t have an actual objection it makes no sense not to cover birth control,” Gandal-Powers says. “Because you end up covering pregnancies instead, which are much more expensive.”
Q. If my employer eliminates contraceptive coverage, what are my options?
A. If you are taking costly birth control pills, ask your doctor if less expensive ones would work as well. Some types of contraception, such as implanted hormones, IUDs, or tubal ligation, come with high up-front costs but minimal costs thereafter. Talk with your provider about payment options. Another option is to turn to your local Planned Parenthood clinic. These offer the full gamut of contraceptive services, billing you on a sliding scale based on your income.
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Nancy Metcalf is an award-winning independent journalist specializing in health topics. A senior writer and editor for Consumer Reports for more than 25 years, she is a nationally recognized expert on health insurance and health reform.