Affordability Lacking for Contraception Under the ACA

In spite of the Affordable Care Act (ACA)'s contraceptive coverage guarantee, there have been some obstacles in ensuring that privately insured women do not encounter out-of-pocket costs, according to a study published in JAMA.

The ACA guarantee says that privately-insured women must receive coverage for FDA-approved contraceptive methods and the included office visit, sterilization procedures, patient education and counseling, follow-up and management of effects, and removal. Not included are supplies without prescription, male contraceptive methods, out-of-network costs, and there are some plans that have received a reprieve.

In saving on out-of-pocket saving, the ACA has the potential to improve public health by reducing financial barriers to contraception and reduce unintended pregnancies and births, and by offering help to women who want to continue their educational and professional goals or better support themselves and their families.

There have been some issues, however, in enacting the ACA requirements and all their intended results. Some insurers have limited the types of contraceptives they cover by only paying for generic versions of oral contraceptives or excluding certain methods of contraception, such as the vaginal ring.

“The whole goal of the ACA is to provide access to needed health care,” Mary Politi, MD, co-author, said in a statement. “But there are numerous situations in which women are not receiving contraceptive services that they are entitled to under the law.”

In order to account for these situations a federal guideline released in May 2015 said that plans must cover at least one form of contraception, without cost sharing, in each of the 18 categories provided by the FDA. Additionally, plans must defer to clinician recommendations when necessary.

Problems with billing have also cropped up when patients have been incorrectly charged for costs that should have been covered by insurance, either through inappropriate insurance practices or through clinician mistakes when applying billing codes. More transparency in communication is then required so that patients know when they are being billed and for what, especially when it is out-of-network.

As such, it is not just the duty of the insurance company, but also of state regulators and healthcare professionals, to follow federal guidelines.

“Improved implementation could ensure that the contraceptive coverage guarantee fully meets its potential to improve women’s preventive care, including contraception,” said co-author Tessa Madden, MD. “We know that access to contraception without out-of-pocket costs reduces unintended pregnancies and births, which can have a great impact on the health of women and families.”