If you’ve got questions about which birth control methods the Affordable Care Act (ACA) does and does not cover, this guide is for you. Below, you’ll find answers to common questions about the ACA and birth control coverage.
Before the ACA, many people would have to shell out thousands of dollars for care.
Colloquially known as “Obamacare,” the ACA offers people health insurance coverage at a lower cost, thus allowing people to save money on healthcare services.
The ACA is also known as the “healthcare law” and the “Patient Protection and Affordable Care Act.”
Protections and benefits under the ACA include things like:
- coverage for people with pre-existing conditions
- eliminated annual and lifetime dollar limits
- free preventative care
- access to parent plans until 26 years old
Another thing that the ACA says, which is what we’ll be narrowing in on in this article, is that employers must cover birth control for their employees.
Anyone who meets all of the following prerequisites is eligible for coverage under the ACA:
- You currently live in the United States.
- You are a U.S. citizen or legal resident.
- You aren’t currently incarcerated.
- Your personal income is no more than 4 times that of the federal poverty level.
A note on that last requirement: The dollar amount will vary year-to-year based on the current poverty level as defined by the federal government.
In 2020 the federal poverty level was $12,760. So, any single person who was making more than $51,040 — 4 times $12,760 — wasn’t eligible for coverage under the ACA.
In 2021, the federal poverty level is $12,880. So, any single person making more than $51,520 isn’t eligible.
“Under the ACA, any person with insurance has access to any FDA-approved birth control method with no copay or no deductible,” explains Sophia Yen, MD, co-founder and CEO of birth control delivery service Pandia Health.
In this case, no copay or deductible = free.
Currently, there are 18
- tubal ligation
- copper IUD
- progestin IUD
- implantable rod
- oral contraceptive combined pill
- oral contraceptive extended continuous use combined pill
- oral contraceptive mini pill (progestin only)
- diaphragm with spermicide
- sponge with spermicide
- cervical cap with spermicide
- internal condom
- emergency contraceptive
The act also covers something they call “the annual well-woman exam,” which includes a:
You can also opt for additional services such as:
No. The terms apply to most health insurance plans, but not all. You’ll need to check with your insurer to find out which birth control services your individual plan covers.
Generally, people on short-term plans and people who have insurance through religiously-affiliated private employers are not covered.
Common employers that are religiously affiliated include:
- nursing homes
Some brand-name birth control pills are not automatically covered under the ACA.
But (!) your doctor or other healthcare provider may be able to “argue” with your insurance to get the brand-name birth control deemed needed be covered, according to Yen.
Want to avoid surprise charges later down the line? Smart!
Just call your health insurance provider ahead of time to find out what costs they will cover.
Check out this guide from CoverHer for tips on exactly what to say to your providers.
The ACA says that insurance plans must cover birth control for people who can get pregnant, as prescribed by a provider.
If you have the emotional and mental capacity to do so, file a complaint. You are entitled to the care you need and deserve, and if you’re not getting that, that’s a THEM issue (not a YOU issue).
To reiterate: Under the ACA, access to birth control is your legal right.
So, if your insurance company isn’t willing to provide you the necessary care you’re entitled to legally under the ACA, you have a legal case.
Great question. But before the answer, some background information: In 2018, the Trump administration issued regulations that allow employers to cite religious or moral objections to covering contraceptives in insurance plans.
Then in July 2020, the Supreme Court green-lit those regulations.
A decision that cost many hundreds of out-of-pocket dollars a year, this ruling got major pushback from preventive care advocates.
Luckily, a brief put out in May 2021 about the provisions President Biden is hoping or planning to make to the ACA seems promising. One of the recommendations for promoting health equality is revising the contraceptive mandate rules.
President Biden is also expected to undo some of the policies put into place by former President Trump. This includes rulings preventing reproductive health organizations (like Planned Parenthood) from receiving government funding.
The Biden administration has also expressed intention to repeal the Hyde Amendment, which blocks federal funds from being used to pay for abortion.
Currently, there is no timeline on when these changes might go into effect. You can track which of Trump’s policies Biden is able to overturn using the Kaiser Health News interactive tracking tool.
This insurance stuff isn’t always straightforward, so odds are you still have questions. To learn more check out the below resources:
Guttmacher Institute: A leading research and policy organization committed to advancing sexual and reproductive health and rights worldwide. On their website, you’ll find a slew of information about birth control and abortion access by state. Their state legislation tracker may be particularly useful.
Planned Parenthood: You may know that Planned Parenthood is a vital reproductive healthcare, sex education, and informational organization. Well, they also have a robust website, complete with information on everything from different birth control options to how to get insurance. This page on the ACA may be particularly helpful.
Gabrielle Kassel is a New York-based sex and wellness writer and CrossFit Level 1 Trainer. She’s become a morning person, tested over 200 vibrators, and eaten, drunk, and brushed with charcoal — all in the name of journalism. In her free time, she can be found reading self-help books and romance novels, bench-pressing, or pole dancing. Follow her on Instagram.