How insurance providers deny access to no-cost birth control

Under the Affordable Care Act (ACA), most health insurance plans are required to provide birth control at no-cost. This means that people covered by these plans can use many contraceptives without copays.

This includes a broad range of contraceptive methods—birth control pills, vaginal rings, diaphragms, sponges, intrauterine devices (IUDs), emergency contraception, and sterilization procedures. It also includes patient education and counseling. What is covered can also vary by state, since some state laws have expanded upon what is covered.

However, many people in the United States who have health insurance coverage find that accessing no-cost birth control is not as simple as it sounds.

There are certain employer-sponsored health insurance plans that are exempt from the birth control mandate. There are also instances where people seeking specific types of birth control face a complicated and time-consuming approval process.

Here, we look at the ways some insurance providers are denying coverage—as well as steps you can take if you feel your insurance provider is billing you for birth control that should be available at no cost.

A brief history of the Birth Control Mandate

The Affordable Care Act is healthcare reform that became federal law in 2010. The goal of the ACA is to increase the number of people in America who are covered by health insurance. Another goal is to support medical innovations that make healthcare more affordable.

In 2012, an amendment to the ACA required health insurance plans to provide no-cost coverage for all contraceptive methods that were approved by the FDA. This is sometimes referred to as the “birth control mandate” or “contraceptive mandate,” though it also required coverage of numerous other preventive healthcare services important to females.

The birth control mandate has been under constant challenge from employers seeking exemption from the mandate for religious reasons. Several supreme court decisions have expanded what organizations and employers can seek exemption from the mandate.

How insurance providers deny coverage

Despite coverage being mandated by the Affordable Care Act, there are reports of health insurance providers denying coverage. The National Women’s Law Center issued a report in 2021 that named several trends in birth control coverage denials:

• Limiting what brands or products are covered. For example, an insurance plan will only provide coverage for a specific brand of birth control pills or vaginal ring—and deny coverage for other brands. This can be a problem when a person experiences a side effect from a specific product and needs to switch to another.
• Difficult exceptions processes. An exception is when a product isn’t normally covered, but it can be covered with approval from an insurance provider. For example, if the type of birth control pill that is covered causes side effects, a person can get an exception to have a different type of pill covered at no cost. The report by The National Women’s Law Center as well as a report by the nonprofit Power to Decide found that many insurance providers do not have a clearly defined process for exceptions.
• Not covering all aspects of care. In some instances, insurance companies are only paying for certain line items on a medical bill. For example, the insurance company may cover an IUD, but may deny coverage for a required follow-up appointment.
• Not covering new birth control products. New birth control products become available regularly. Unfortunately, these products can be left out of coverage policies, and therefore only available to people paying out of pocket. This problem has been attributed to the Food & Drug Administration (FDA), which has been slow in updating its Birth Control Guide—a document that informs how coverage policies are written.

There is evidence that many insurance plans are in violation of the ACA, and there is pressure on the government to take action.

In July 2022, the federal government issued a letter to health insurance providers, warning companies to remove barriers like those described in the bullet points above. The letter was signed by the Department of Health and Human Services, the Department of Treasury, and the Department of Labor.

What to do if you are paying for birth control

If you’ve been paying out of pocket for birth control and believe that your insurance provider may be in violation of this law, a good first step is to review your insurance policy and contact your insurance provider. Ask for an explanation of what is covered and what isn’t covered.

If you are concerned that your health insurance provider is not complying with the ACA’s birth control mandate, there are organizations you can contact to report a potential violation.

• If you’re employed by a state or local government and have insurance through your employer, you can contact the Health Insurance Assistance Team of the US Center for Consumer Information and Insurance Oversight by calling 1-888-393-2789 or emailing phig@cms.hhs.gov.
• If you have private insurance through a non-government employer, you can contact the Department of Labor by visiting askebsa.dol.gov. Go to the “Tell Us About Online” section and then select “File a Complaint.” You can also call 1-866-444-3272.

If you would like to read more about the ACA, the birth control mandate, and no-cost birth control, here are a few places to visit:

• You can read the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury’s letter to health insurance companies issued in June 2022.
• You can also read the 2021 report by the National Women’s Law Center, which discusses trends in birth control coverage denials.
• You can also read a report by the nonprofit organization Power to Decide, which provides analysis on exceptions policies, denial letters, and state laws regarding contraceptive coverage.
• Some states have passed laws to expand upon what contraceptives are covered at no cost. The nonprofit organization the Guttmacher Institute has a breakdown of contraceptive coverage by state.