Will Obamacare Get You Free Birth Control?

That’s not as easy to answer as you might think. Here’s the lowdown on what the ‘contraceptive mandate’ really means.

Obamacare birth control

Obamacare includes a controversial provision for birth control. (Stockbyte/Getty Images)

Adrianna McIntyre is a graduate student at the University of Michigan.

In case you haven’t heard, the health reform law—the Affordable Care Act, aka Obamacare—includes a popular but also controversial provision for birth control: what’s been called the “contraceptive mandate.” Simply put, it’s a rule that employers must offer insurance plans that cover birth control without co-payment. Most health insurance plans were required to offer birth control without co-pays by January 1, 2013, and for many plans, it kicked in in August 2013. But the birth control requirement, which is almost fully phased-in, still doesn’t mean you’ll automatically get your contraception covered at no cost. Here are a few things to consider:

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Have you had your health insurance plan for over three years?

If you’ve been enrolled in the same insurance since March 23, 2010 (the day the Affordable Care Act was signed into law), it’s possible your plan was “grandfathered,” which means your insurer was given extra time before it was required to put in place changes required by the reform, including those covering birth control. That said, all employers must adhere to this requirement by August 1, 2013, according to the Secretary of Health and Human Services. Unless…

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Do you work for a religious employer?

Religious entities like churches, temples, and mosques are exempt from the Obamacare requirement. Religiously-affiliated institutions (think Catholic hospitals or universities) are not exempt, which has unleashed a years-long controversy. The Obama Administration has crafted a complex “religious accommodation,” which effectively requires insurers to absorb the cost of contraceptives for those institutions. This regulation is still being finalized, but it’s received over 147,000 comments—more than any U.S. regulation in history. Additionally, there are now 60 lawsuits against the government challenging the contraceptive mandate on religious grounds. Some experts think the issue could be taken up by the Supreme Court as early as winter 2014.

What kind of birth control do you use?  

Insurers are required to cover all types of birth control, but that’s not the same thing as covering all brands. So there might be a specific set of generic oral contraceptives (the Pill) that are free of co-pays, but the brand-name versions—think Yaz or Ortho Tri-Cyclen—will still probably require an additional co-pay.

But other forms of birth control should be covered without co-pay, too, like the patch, NuvaRing, “the shot” (DepoProvera), contraceptive sponges, spermicides, cervical caps, and intrauterine devices (IUDs). The specifics will vary from insurer to insurer; call your insurer to learn more. (The National Women’s Law Center has a handy guide too.)

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As a side note, it’s worth considering an IUD if you haven’t before These small, T-shaped devices are inserted into the uterus by a doctor to prevent pregnancy. Though expensive up front (they cost about $500 to $1,000), IUDs are the longest-lasting form of reversible birth control; they can be left in place up to 12 years, and they’re effortless—no need to remember a daily pill.

IUDs have suffered an image problem since the 1970s, when one brand (long off the market) resulted in a host of awful side effects, and clinicians have been reluctant to prescribe IUDs until after women have given birth. But research is debunking myths about these contraceptive devices (which are recommended by the American College of Obstetricians and Gynecologists, the leading professional medical association for physicians who treat women’s health). One study found no increase in complications among teenagers using IUDs when compared to older women. There’s still a rare risk of IUD-related pelvic inflammatory disease, which can cause infertility—but oral contraceptives come with the chance of rare complications, too, like increased risk of blood clots, stroke, heart problems, and breast cancer.

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And while you may not have to shell out $10 or $20 when you pick up your birth control at the pharmacy, there’s no such thing as truly free contraception. The expense will, of course, be built into the cost of your overall insurance plan. There’s some evidence that birth control is cost-saving (pregnancy is expensive, and comes with a risk of complications), but results are mixed.

For now, the Obamacare contraceptive mandate marks an important step forward in women’s access to preventive services. One study found that over half of women delayed or skipped preventive care because of costs, and fully one-third of all births—not pregnancies, but births—are unplanned. Assuming it survives the legal tussle, the contraceptive mandate might finally start to change that and give women more options and more control over their health—and their reproductive health in particular.

Will Obamacare cover the birth control you use? Are you in favor or against the contraceptive mandate?

Adrianna McIntyre is a graduate student at the University of Michigan, where she studies public policy and public health. She blogs about health policy on Project Millennial, which she cofounded and manages. Before graduate school, she worked in clinical research regulation. Adrianna holds a degree in cognitive science with minors in political science and history, also from the University of Michigan. @onceuponA | TakePart.com

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