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Physicians are praising new guidance from the federal government aiming to ensure that insurers are properly covering contraception methods and services as required under the Affordable Care Act.
On May 11, the departments of Health & Human Services (HHS), Labor, and the Treasury issued guidance to insurers clarifying that they must cover – without cost-sharing – at least one form of contraception under each of the Food and Drug Administration’s approved birth control methods. This includes the ring, the patch and intrauterine devices.
Dr. Mark S. DeFrancesco, president of the American Congress of Obstetricians and Gynecologists (ACOG), lauded the guidance, calling it much needed to compel insurers to comply with the ACA’s birth control requirements.
Dr. Mark S. DeFrancesco
“ACOG hopes that today’s clarification from the administration will help ensure that all FDA-approved methods of birth control are covered by insurance companies, as mandated by the Affordable Care Act, so that every woman is able to get the contraceptive that is right for her,” Dr. DeFrancesco said in a statement. “We will continue to monitor insurance coverage practices regarding preventive services, including contraceptives, and look forward to continued work with HHS to ensure full and appropriate implementation of the ACA’s mandates.”
In its announcement, HHS acknowledged that insurance companies have been confused about the specific types of contraception that should be covered under the ACA, and that the government has received complaints by patients, doctors, and lawmakers about the lack of coverage.
The ACA requires that preventive services such as contraception and well-woman visits be covered without out-of-pocket expenses like copays or deductibles. However, recent reports by the National Women’s Law Center and the Kaiser Family Foundation found that insurers were frequently dismissing the requirements.
In its guidance, the government said insurers must cover at least one form of contraception under each of the 18 methods that the FDA identifies in its current Birth Control Guide.
One problem identified in the Kaiser Family Foundation report was that some insurers covering oral contraceptives with no cost sharing were imposing copays for the vaginal contraceptive ring. The rationale was that the contraceptives had an equivalent chemical composition and only differed in the delivery method. Under the newly issued guidance, that approach would be prohibited.
For hormonal methods, plans must cover (without cost sharing) all three oral contraceptive methods (combined, progestin-only, and extended/continuous use), injectables, implants, the vaginal contraceptive ring, the contraceptive patch, emergency contraception (Plan B/Plan B One Step/Next Choice), emergency contraception (Ella), and IUDs with progestin.
Additionally, the guidance clarifies that, if a woman is at increased risk for having a harmful mutation in genes that suppress tumors – the BRCA-1 or BRCA-2 cancer susceptibility gene – a plan must cover her preventive screening, genetic counseling, and BRCA genetic testing with no cost-sharing.
Dr. Nancy L. Stanwood
Insurers also cannot limit preventive services based on an individual’s sex assigned at birth, gender identity, or recorded gender. Health plans also must cover preventive services that a patient’s provider – not an insurance company – determines are medically appropriate.
The instructions make clear a health plan covering dependent children must provide recommended preventive services for those dependents, including services related to pregnancy, preconception, and prenatal care. HHS adds that insurers cannot impose cost-sharing for anesthesia services performed in connection with preventive colonoscopies.
Physicians are grateful to see the guidance being issued after encountering many cases in which insurers have refused to cover needed women’s care, said Dr. Nancy L. Stanwood, board chair for Physicians for Reproductive Health.
“As physicians, we have seen multiple cases of women being wrongfully denied contraceptive coverage they have paid for and are entitled to by law,” Dr. Stanwood said in a statement. “Today’s announcement by the administration says loud and clear that plans must cover the full range of contraceptive methods, and women’s health will be better for it.”
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