411 on Birth Control in an ACA World
Wondering why you had to pay for birth control recently when you thought it would be free?
So did MomsRising members.
Over the last couple of weeks, we’ve received questions from women who have tried to fill their birth control prescription with their new marketplace coverage (believing there will be no co-pay) to find that they had to pay for the prescription. In response to these questions, I wrote this blog post to help our community know why this is happening and that there are options available.
Why am I being charged for my birth control?
ACA compliant plans “must cover contraceptive methods and counseling for all women” and plans “must cover the services without charging a copayment, coinsurance, or deductible.” This is absolutely on point, but what it means is that all methods of birth control must be covered, but not necessarily all brands—some times referred to as tiers (1, 2, 3, or 4) or formulas.
As discussed by Chelsey Delaney in her recent BedSider article, insurance providers categorize prescriptions based on the formula, ranging from more affordable generic drugs to expensive brand name versions. These formulas can change often, so if you find that your birth control used to be free and now it isn’t, it may be because the formula on your current prescription changed:
“NWLC clarified for me that the ACA requires all unique methods of birth control to be fully covered. That means that if a brand name contraceptive method doesn’t have a generic equivalent, it has to be covered. NWLC informed me that formularies change frequently…What happened in my situation was that my birth control was bumped from a lower tier to a higher tier when its generic was added to the formulary.”
If the same thing happened to you, there are still options to get free birth control (see next section), but there might be other reasons it isn’t free—like your employer or the status of your plan. See this Buzzfeed image to help you figure out why you might be paying for your birth control:
CREDIT: Chris Ritter for BuzzFeed
Am I stuck paying for my birth control?
No, not necessarily.
There are several options of what you can do next. If there is a generic version of your birth control, you should check with your doctor and see if switching to a generic version of your birth control would work for you. You might even want to bring your insurance company’s list of covered birth controls to help make the process smoother.
If there is no generic or the generic doesn’t work for you as directed by your doctor, you are still in luck! You can appeal the insurance provider in both of these instances.
To learn more about how to appeal, check out the National Women’s Law Center Getting the Coverage You Deserve toolkit for tips, sample letters, and additional resources to help you troubleshoot and be on your way to having co-pay free birth control—because it’s totally so last year!
If you still have questions about this or other parts of your new marketplace coverage, please email us at firstname.lastname@example.org.