It depends. Your Family Planning Clinic may be a covered provider in your new health plan network. If so, you can continue to go there for your birth control without cost-sharing. If your Family Planning Clinic is not in the network, you may still qualify for free or reduced cost services from the clinic. Check with your clinic for more information.
The rules affecting student health plans are complicated and depend on the type of plan your college or university may offer. If your student health plan is fully-insured, it should cover all 18 FDA-approved contraceptive methods for women as prescribed, without cost sharing. However, if your college or university has a religious objection to providing contraceptive coverage, then it may have opted to have the insurance company provide the coverage directly to policyholders. Some universities have legally challenged the contraceptive coverage rule. While this litigation is ongoing, some universities may have excluded contraceptive coverage from their student health plan.
If your college has a self-funded health plan, then it is not subject to requirements under the Affordable Care Act, including covering contraceptives with no cost sharing. Ask your college if the plan is self-funded. If it is self-funded, state laws that may require some coverage of contraceptives. Check with your State Insurance Department about the state law. You may have other options as well. If you are under 26, you should check if you are eligible as a dependent in your parent’s health plan. You can also consider buying coverage on your own through the Marketplace. If your income is between 100% and 400% of the federal poverty level and you meet other requirements, you can qualify for premium tax credits; if you income is between 100% and 250% of the federal poverty level, you can also qualify for cost sharing reductions. In addition, you might be eligible for Medicaid. Check with your state Marketplace to find out if you meet the income and other eligibility standards to enroll in Medicaid coverage.
Most non-grandfathered plans (plans that started or made changes after March 23, 2010) must provide contraceptives and related services with no cost sharing when they are obtained through an in-network provider. Plans must cover at least one type of each of the 18 FDA approved methods for women. There are three categories of birth control pills that must be covered: combined hormone, progestin only, and extended/continuous use. However, plans may use reasonable medical management to limit the scope of oral contraceptive coverage within each of these three categories. For example, plans may cover generic oral contraceptives without cost sharing but impose some out-of-pocket charges for equivalent branded drugs. Check with your provider if there is a generic birth control pill available that will work for you. If there is no generic alternative or there is a medical reason you need to use a brand name birth control pill or device, ask your provider to help you request a “waiver” or “exception” from the insurance company. The “waiver” or “exception” would allow you to use the brand name drug or device with no co-payment.
In May 2015, the federal government clarified that ACA-compliant plans must cover at least one type of each of the 18 FDA approved methods for women. The NuvaRing is the only available vaginal ring, so plans must cover the NuvaRing without cost sharing.
If your plan does not cover the NuvaRing without a co-payment, you should file an appeal with your insurance plan or check with your State Department of Insurance if you are on an individual plan or with the Federal Department of Labor if you are on a group plan.
Short-term health insurance policies do not have to provide benefits required by the ACA and may not cover preventive services, including contraceptive services.
There are two kinds of IUDs: Hormonal and Copper. The federal law requires most ACA-compliant, “non-grandfathered” plans to cover at least one hormonal IUD (marketed as Mirena, Skyla, Lilleta or Kyleena) as well as the copper IUD (brand name ParaGard) with no cost sharing. The plans must also cover the provider visits for insertion and removal, with no cost sharing. You should talk to your provider about which IUD is best for you. If your plan will not initially cover the hormonal IUD your provider recommends, you should ask your provider to request a “waiver” or “exception” from your insurance plan. However, there are certain types of employers with religious objections to contraception that are not required to provide contraceptive services to their workers and dependents.
Short-term health insurance policies do not have to provide benefits required by the ACA, including contraceptive services.
Yes, your plan must cover the full range of FDA-approved contraceptive methods, but can impose some restrictions on the contraceptives offered at no cost to you. For example, the plan may require that you choose a provider within the network, and use generic rather than brand name contraceptives, unless the brand name is medically necessary. If the generic drug or device does not work for you, you can ask your doctor to request a waiver from the insurance plan to receive the brand name drug or device without cost sharing.
If you believe you are at higher risk, you should discuss with your provider. There are a number of breast cancer screenings and preventive services that insurers must cover for women. If you are enrolled in an ACA-compliant, non-grandfathered plan, your insurance must pay for your provider to assess whether you have a have a family history that makes you at higher risk for certain genetic mutations that are associated with increased risk of breast cancer (BRCA1 and BRCA2). If your provider determines that your family history makes you at increased risk for genetic mutations, your plan must cover the full cost of genetic counseling and genetic testing if recommended. If you end up having one of these genetic mutations, your insurer is also required to cover the full cost of certain preventive medications which can greatly reduce your risk of getting breast or ovarian cancer.
The coverage rule for mammography is based on the Women’s Preventive Services Initiative, adopted by HRSA, that recommends screening mammography every one to two years for women age 40 – 74 years. Since you are under age 40, federal rules do not specify whether your plan must cover the costs of the screening mammogram without cost sharing.
Short-term health insurance policies do not have to provide benefits required by the ACA, including preventive services such as mammography.
The ACA includes a number of preventive services for women that ACA-compliant, “non-grandfathered” private plans are required to cover without cost sharing. For example, these include counseling and screening services including prenatal and preconception care; breast and cervical cancer screening; genetic counseling and testing for women at high risk of breast cancer; Chlamydia and Gonorrhea screening and counseling for high risk women; at least one well woman visit a year; contraceptive counseling, services and supplies including prescriptions for FDA approved contraceptives; breastfeeding counseling and support services including breast pump rental; and intimate partner violence screening and counseling. So long as the preventive service is performed by an in-network provider, is not billed separately from the office visit, and is the main reason for the office visit, then the visit and the preventive service will be covered by the insurer without cost sharing.
Short-term health insurance policies do not have to provide benefits required by the ACA and may not cover preventive services.
Your plan is required to cover a wide range of preventive services and may not impose cost-sharing charges (such as copayments, deductibles, or co-insurance) If you are enrolled in an ACA-compliant, non-grandfathered plan, including plans offered through the Marketplace. The ACA requires private plans to provide coverage for services under four broad categories: evidence-based screenings and counseling, routine immunizations, childhood preventive services, and preventive services for women. So long as the preventive service is performed by an in-network provider, is not billed separately from the office visit, and is the main reason for the office visit, then the visit and the preventive service will be covered by the insurer without cost-sharing.
If you buy coverage on your own and you first purchased your policy prior to March 23, 2010, it may be a grandfathered plan. These plans are not required to cover preventive services without cost sharing. If you are not sure if your plan is grandfathered, check with your employer or your insurance plan.
In addition, short-term health insurance policies do not have to provide benefits required by the ACA and may not cover preventive services.