Last week, Senator Bernie Sanders of Vermont, chairman of the Senate Health Committee, called on a government watchdog to investigate why insurance companies continue to charge women for birth control, a move that brought access to contraceptives back into the spotlight.
In a letter to the Government Accountability Office, the senator noted that insurance companies are charging Americans for contraceptives that, under federal law, should be free — and that they are also denying appeals from consumers seeking to have their contraceptives covered. Some experts estimate that such practices could affect access to birth control for millions of women.
Since 2012, the Affordable Care Act has required that private insurance plans cover the “full range” of Food and Drug Administration-approved contraceptives for women, including female sterilizers, emergency contraceptives, and any new FDA-approved products . The mandate also covers services associated with contraceptives, such as counseling, insertions or removals, and follow-up care.
This means consumers should not have any copays associated with in-network providers, even if they have not met their deductibles. Some plans may only cover generic versions of some contraceptives, but patients are still entitled to coverage of a specific product that their providers deem medically necessary. Medicaid plans have a similar provision; the only exception to the mandate are plans sponsored by employers or universities that have religious or moral objections.
Yet many insurers still charge for contraceptives, some in the form of copays, others by denying coverage altogether.
A quarter of women pay for contraceptives needlessly
In his letter, Senator Sanders cited a recent survey conducted by KFF, a nonprofit health policy research organization, which found that about 25 percent of women with private insurance plans said they paid at least part of the cost of birth control; 16% reported that their insurance plans offered partial coverage, and 6% noted that their plans did not cover contraceptives at all. Additionally, a 2022 congressional investigation that analyzed 68 health plans found that the process for requesting exceptions and covering contraceptives was “burdensome” for consumers and that insurance companies denied, on average, at least the 40% of exception requests.
In a response letter to Congress earlier this year, AHIP, a national advocacy group representing insurance companies, noted that the group “will continue to work with the Administration, Congress, and policymakers to ensure that consumers have affordable access to contraception in line with the law.”
Although the federal mandate has been in place for more than a decade, companies continue to evade the law because “these mandates are rarely enforced and the penalties for ignoring them are relatively low,” said Anna Bahr, Senator Sanders' communications director. . Every time a company is penalized, it finds other ways to deny coverage, she said.
In 2015, a study by the National Women's Law Center, a nonprofit legal organization, found that several insurance companies said they didn't cover hormonal rings, intrauterine devices or patches because they covered another hormonal method: birth control pills. This practice was a violation of the mandate and prompted the Obama administration to crack down.
Today, consumer complaints are a little different, said Gretchen Borchelt, vice president for reproductive rights and health at the Law Center. The group heard from women whose plans come with a “trial and fail” warning, where patients are expected to try specific products, usually oral contraceptive pills, until they “fail”, before they can get the contraceptive option that they want and that their supplier recommends to them.
Earlier this year, the Department of Labor, which is one of three government agencies responsible for enforcing the mandate of the Affordable Care Act, called the practice “problematic.”
Insurance companies also often deny coverage for new FDA-approved contraceptives, said Alina Salganicoff, senior vice president and director of women's health policy at KFF. The organization also found that companies might cover a birth control product, such as an IUD, but deny coverage of associated services, such as insertion or removal, she said. The share of women with private insurance who paid nothing for their IUDs or implants has been declining since 2015, according to a study released last summer.
What to do if you are accused of contraception
Talk to both your doctor and your insurance company and remind them that the law says you shouldn't pay, Ms. Salganicoff said.
You can also call the National Women's Law Center hotline, which will help you take a hard look at your plan to figure out what the problem is, Ms. Borchelt said. Sometimes the hotline is able to help patients get refunds.
Consumers should also notify their representatives, he said, because complaints like these can often be investigated.
Complaints from Vermont consumers prompted a two-year investigation into the country's health insurance plans, which found that nearly 9,000 people had been wrongly charged for contraceptives. As a result, the state last year ordered insurance companies to issue $1.5 million in refunds.
“Public pressure helps a lot,” Ms. Borchelt said.