Birth Control Coverage Under the Affordable Care Act (ACA)

We know deciphering the Affordable Care Act and how it affects the type of birth control available to you can be confusing.

If you’ve ever wondered what the difference is between the Affordable Care Act and Obamacare or what a copay vs. a deductible is, you’re not the only one. Keep reading to learn more about the Affordable Care Act (ACA) and what it means for your birth control.  

What is the Affordable Care Act (ACA)?
‍The Affordable Care Act (ACA) was implemented by President Obama in 2010 to make affordable health insurance available to more people and expand the Medicaid program. You may have heard the ACA referred to as Obamacare.

How does the ACA affect birth control?
‍The Affordable Care Act says that insurance plans must cover birth control and counseling for all women. Before the ACA, birth control made up 30-44% of total out-of-pocket healthcare costs for women, so it has made a big difference in providing affordable options for contraception. These services often do not require a copay if you use an in-network provider, meaning if you find a doctor that your insurance approves of you may not have to pay anything!

Which birth control methods are covered under the ACA?

• Barrier methods (diaphragms, sponges)
• Hormonal methods (pills, rings, patches)
• Implanted devices (IUDs, implants)
• Emergency contraception
• Sterilization

Insurance plans are only required to cover one type of birth control in each of the 18 categories of contraception (see the full list here), which means your preferred brand may not always be covered, but a similar type of birth control will be. This is why you have a $0 copay with some, but not all, birth control brands.

Additionally, insurance companies require pharmacies to fill a generic instead of the brand name. If you need a specific brand for medical reasons, you can ask the doctor to write the prescription with a specific note that says “dispense as written (DAW)” to not allow any substitutions.

If you work for a religious employer, they are not required to cover contraceptive methods and counseling, so you may need to pay out-of-pocket.

FAQs about Insurance and Copays

How do I sign up for insurance coverage through the ACA? You can visit this website to get started.

What is the difference between the ACA and Medicaid? The goal of the ACA is to provide better coverage for all Americans, whereas the Medicaid program is for a specific group of people (including low-income people, families and children, pregnant women, the elderly, and people with disabilities). The ACA is run by the federal government and Medicaid is run by each state separately. Learn more about the Medicaid program, eligibility and coverage here.

What’s the difference between a copay and a deductible?

• Copay: When you receive a prescription for a medication, such as birth control, your insurance may cover the full cost or they may cover only part of the cost. If you are required to pay part of the cost, it’s called a copay. You would pay this each time the pharmacy dispenses your birth control. For example, if your insurance allows the pharmacy to dispense one month of birth control at a time and you have a $5 copay, you would pay $5 each month.

• Deductible: A deductible is a certain amount of money you have to pay over the course of a year before your insurance kicks in and will start covering your expenses. If you are surprised to hear from your pharmacy that you have a very high copay that you’ve never seen before, it may be due to your deductible. If you’re unsure what your deductible is, you can call your insurance to find out. There is typically a Member Services phone number listed on your insurance card.

Why do I have a copay for my brand now when I didn’t have one before?
‍Insurance companies can change what they cover and what they require for a copay. Just because your brand was covered previously, does not mean it will always be covered. Similarly, if you switch insurance companies, the cost of your birth control may change.

One common brand that causes confusion is the Depo Shot. Insurance companies may cover the type of Depo Shot that is administered by a doctor, but not the Depo Shot that can be self-administered at home (which is what Twentyeight Health offers).

To find out which brands and generics your insurance covers, you can request their “formulary,” which will list the options for you. Formularies can change over time, so if you are unsure about your latest coverage, it is helpful to reach out to your insurance company to double check.

If you have additional questions about your coverage, we’re here to help! Please reach out to contact@twentyeighthealth.com for assistance.