BACKGROUND

Contraception is crucial for helping people to avoid unintended pregnancies, and it has myriad health, social and economical benefits for individuals and families. Since the mid-1990s, 28 states have required wellness insurance plans regulated by the land that provide coverage of prescription drugs and devices to also cover prescription contraceptives.

Federal police force, under a provision of the Affordable Care Act of 2010, expanded on these country policies in several ways. The federal contraceptive coverage guarantee applies to most private health plans nationwide; information technology specifically requires coverage for 18 methods of contraception used past women (including female person sterilization), along with related counseling and services; and it requires this coverage to be provided without whatever cost sharing by patients (i.eastward., out-of-pocket payments, such as copayments or deductibles). In administering this coverage, health plans may use formularies, prior dominance requirements and similar restrictions to affect patients' choices only within a method category, but not across method types. In other words, for example, health plans may favor one type of hormonal IUD over some other, just they may not direct patients to apply IUDs over oral contraceptives.

More recently, some states accept amended and expanded their own requirements to friction match the standard ready in the federal guarantee past specifically requiring coverage for the full range of contraceptive methods, counseling and services used past women; eliminating out-of-pocket costs; and limiting other health program restrictions. Moreover, some of these new state provisions go beyond the federal guarantee, by requiring coverage for contraceptive methods that are available over the counter without requiring the patient to first obtain a prescription, ensuring that people may receive a vi-month or one-year supply of a method at one time (rather than more typical one- or 3-month supplies), or requiring coverage of vasectomy without patient out-of-pocket costs.

STATE LAWS AND POLICIES

For a chart of current laws and policies in each state related to contraceptive coverage, meet Insurance Coverage of Contraceptives.

For information on state laws and policies related to other sexual and reproductive health and rights issues, come across State Laws and Policies, issue-past-issue fact sheets updated monthly by the Guttmacher Institute'south policy analysts to reflect the most recent legislative, administrative and judicial actions.

RELEVANT DATA AND ANALYSIS

Importance of Method Choice

Contraception is widely used to help people avoid unintended pregnancies, and having a choice among a wide range of contraceptive methods helps them to exercise so.

  • More than 99% of women aged 15–44 who accept ever had sexual intercourse have used at least ane contraceptive method.1
  • Although using whatever method of contraception is more constructive in preventing pregnancy than not using a method at all, every person should have access to the full range of contraceptives to find the methods that best fit their needs.2
  • Contraceptive methods are non interchangeable. Methods differ in terms of effectiveness, side furnishings, drug interactions, use of hormones, cost, confidentiality concerns and the degree of control individuals have over their use. A person'southward contraceptive needs may vary over their reproductive lifetime: More than three-fourths of U.S. women have used 3 or more different methods by age 44.ane
  • The desirability of a particular contraceptive method may vary depending on an individual's preferences and situation. For case, some people may need a method that tin exist used just before having sex, while others (or the same person at different times) may prefer a method that does not require the user to remember it each time.
  • In a 2010 written report of women seeking ballgame, currently available contraceptive methods had between 37% and 67% of what participants considered extremely important features. Fewer than ane-3rd of women rated about methods every bit "good" matches (coming together 75% of their needs).3
  • Satisfaction with a method influences whether women use their method consistently and correctly. For example, according to surveys in 2004–2005, 48% of dissatisfied pill users had skipped at least one pill in the previous three months, compared with 35% of completely satisfied pill users. Overall, thirty% of neutral or dissatisfied method users reported a temporal gap in use, compared with 12% of completely satisfied users.four
  • Consequent use matters: Two-thirds of women at risk for unintended pregnancy who consistently and correctly used a contraceptive method accounted for just five% of unintended pregnancies in 2008.5

Documented Benefits of Contraception

Contraception has health, social and economical benefits for individuals and their families.

  • Contraceptive use helps individuals and couples command the timing, number and spacing of births, thus reducing the likelihood of premature birth or low birth weight.6
  • Contraceptive use can prevent preexisting health conditions from worsening and new wellness problems from arising as a upshot of unintended pregnancy. Unintended pregnancy can exacerbate existing health conditions such as diabetes, hypertension and heart disease,7 and is too a take chances factor for depression in adults.8,9
  • Isolating contraceptive services from broader health insurance coverage can force people to receive their contraceptive care separately from other primary and preventive services. This tin disrupt continuity of care, reduce patients' ability to see the provider of their pick at the time or place they need, and stigmatize contraceptive services by treating them equally different from or less of import than other wellness intendance.x
  • Contraception can aid women see their educational, financial and other personal goals.
    • In a 2016 national survey of women aged eighteen–44, a majority of respondents agreed that an unplanned birth would take negative effects on a woman's life, including her education, job, income and mental wellness.11 Most respondents also said that contraception has positive furnishings beyond preventing pregnancy, such equally reduced stress, wellness benefits and continued ability to work.12
    • In a 2011 report examining women's reasons for using contraceptives, many women reported that using birth control to foreclose pregnancy enabled them to support themselves financially (56%), meet their educational goals (51%) and get or keep a job (50%).thirteen
    • Economic analyses have plant positive associations between the availability of oral contraceptives and U.Due south. women's education, labor force participation and average earnings, too equally a reduction in the wage gap between women and men.xiv

Cost Barriers to Admission

The cost of methods can reduce contraceptive choices. Insurance coverage—particularly without price sharing—can help people overcome this barrier to using a preferred method.

  • Price matters to women when choosing a contraceptive method.
    • Among women aged 18–44 surveyed in 2016, more than 70% said that it was "extremely or quite important" for their contraceptive method to be low cost.12
    • Some of the well-nigh effective contraceptive methods are also the most expensive. For case, an IUD is 88 times as effective as a male prophylactic in preventing pregnancy during the starting time twelvemonth of typical use,10,15 only the cost of an IUD tin be much college—sometimes exceeding $500 (non including costs related to insertion).16 The full cost of initiating a long-interim method generally exceeds $1,000.17 To put that cost in perspective, beginning to use one of these devices costs nearly a month's full-fourth dimension salary at the federal minimum wage of $vii.25 an hr.
    • In a 2007–2008 study, women who had to pay high out-of-pocket costs were significantly less probable to obtain an IUD than women who paid less than $50. Overall, but 25% of women in the study who requested an IUD had i placed later on learning the associated costs.18
    • In a written report conducted prior to implementation of the federal contraceptive coverage guarantee, almost one-tertiary of women reported that they would modify their contraceptive method if cost were not an issue.19
  • Numerous studies have demonstrated that even seemingly modest copayments and other cost-sharing requirements tin dramatically reduce preventive health care utilise, particularly among low-income Americans.twenty
  • Extensive empirical evidence demonstrates that eliminating costs leads to more constructive and continuous use of contraception.2
    • According to information from a 2006–2008 survey, women aged fifteen–44 with private health insurance living in states that required individual insurers to cover prescription contraceptives were 64% more than likely to utilise a contraceptive method during each sexually active calendar month than those living in states with no such requirement, even after bookkeeping for differences in education and income.21
    • In a 2015 survey of uninsured women, most one-half of respondents said that having health insurance would help them afford birth control, choose a better method and apply that method consistently.22

Benefits of the Federal Coverage Guarantee

The federal contraceptive coverage guarantee has had important benefits for women.

  • The contraceptive coverage guarantee requires nigh private insurance plans to cover the full range of "female-controlled" contraceptive methods without cost sharing (copayments or deductibles).23
  • Fewer women pay out of pocket for their birth command since implementation of the contraceptive coverage guarantee.
    • Between fall 2012 and leap 2014 (during which time the coverage guarantee went into wide effect), the proportion of privately insured women who paid nothing out of pocket for oral contraceptives increased from 15% to 67%. Similar increases occurred among those using injectable contraceptives, the vaginal ring and IUDs.24
    • In a 2016 national survey, ii-thirds of women reported that the full price of their prescription nascence control method had been covered by their health insurance plan or another program in the previous six months.12
    • Contraceptive pill users saved an estimated average of $255 in copayments in 2013 because of the contraceptive coverage guarantee.25
    • As of 2017, virtually 58 million women had coverage of nascence command without cost sharing.25
  • Eliminating toll sharing in insurance coverage tin can reduce financial barriers to the use of a chosen contraceptive method.
    • In a written report of 2010–2013 health insurance claims, women using generic nascence control pills who had contraceptive coverage without cost sharing post-obit the coverage mandate's implementation were more likely to go along and consistently apply their method than women using generic pills with even small out-of-pocket costs.26
    • In a 2015 survey of women who had wellness insurance and used a hormonal contraceptive method, two-thirds of respondents had no copayments. Amongst women with no copayments, fourscore% reported that paying null out of pocket helped them to afford and utilize their birth control, more than seventy% reported information technology helped them use their nascency command consistently and 60% reported information technology helped them cull a better method.22
  • Several studies have found that contraceptive coverage without cost sharing has influenced women's contraceptive method choices. However, the influence of the guarantee on overall contraceptive apply is still unclear.
    • A report of private health insurance claims from 2008–2014 found that the reduction in cost sharing because of the contraceptive coverage guarantee was tied to a significant increment in the use of prescription methods, particularly long-acting methods.27
    • Some other written report of health insurance claims from 2010–2013 showed that the rate of discontinuation and inconsistent use of contraception declined among women using generic oral contraceptive pills later on the contraceptive mandate's implementation; amidst women using brand-name oral contraceptives, discontinuation and nonadherence rates declined when the out-of-pocket expense was higher than $30.26
    • A written report of contraceptive use plant that between 2012 and 2015, utilise of prescription birth control pills increased among sexually inactive women, suggesting that more women were able to use the pill for reasons other than contraception after implementation of the contraceptive coverage guarantee.22
    • The same study found that since the guarantee'south implementation, in that location has been no change in overall contraceptive employ among women at risk of unintended pregnancy, suggesting that insurance coverage may not accept been the just barrier preventing women from obtaining the method of their choice.22
  • A 2017 written report projected that for every i 1000000 women aged xv–44 who lose private insurance coverage for contraceptives, in that location would be 33,000 more unintended pregnancies and 13,000 more abortions each year.28

State Actions to Reinforce the Coverage Mandate

Implementing or expanding state requirements could reinforce the federal contraceptive coverage guarantee and help state agencies enforce information technology.

  • In 2015, studies by the National Women's Law Center and the Kaiser Family Foundation identified several major problems areas with insurance plans' interpretation and implementation of the guarantee. For example, many plans were not providing coverage for all contraceptive methods used past women, were only covering generic equivalents of brand-name birth control products or were charging out-of-pocket fees for services associated with receiving birth control.29,30
  • In 2013 and 2015, the federal government issued details clarifying the contraceptive coverage guarantee, including that insurers must cover xviii specific methods without price sharing, coverage must include all services related to contraception (such as counseling, insertion and removal of IUDs and implants, and follow-upwards care), and issuers may utilize medical management techniques (such as requiring prior authorization from the health plan) merely for products within a given method category, but non in a manner that interferes with an individual's pick across methods.31,32
  • Following the 2015 federal guidance, the National Women's Law Center documented that fewer consumers reported their insurance plans were excluding coverage of specific nascence command methods or limiting coverage to generic versions.33 However, some plans continued to exclude coverage for tests or other services associated with receiving birth control and to impose a maximum age limit on coverage.

Coverage Guarantee Expansion Options

Expanding the federal contraceptive coverage guarantee to include insurance coverage for over-the-counter methods without a prescription, extended supplies of contraceptives at one time and methods of contraception used by men can aid people get and consistently apply the method of their choice.

  • Under the contraceptive coverage guarantee, insurers only have to cover over-the-counter contraceptives for which enrollees accept a prescription. Coverage of over-the-counter contraceptive methods without need for a prescription has the potential to amend contraceptive utilize and, in plow, reduce unintended pregnancy rates, especially among women who lack the time to visit a wellness care provider, would need to arrange for child care or otherwise observe information technology difficult to seek out a prescription.34
  • Currently, nearly insurance plans cover only i–iii months' worth of oral contraceptives at a time. When individuals run out of pills or take difficulty obtaining prescription refills, they may experience gaps in employ or cease using contraceptives altogether, which in plough may pb to unintended pregnancies.
    • A 2007–2009 study found that women who received a seven-month supply of oral contraceptive pills at once without cost sharing were more than likely to continue utilize for half-dozen months than those who received a three-month supply.35
    • A 2006 report found that women who received a full year'south supply of oral contraceptives without cost sharing were less likely to get pregnant within a twelvemonth than women who received a one- or three-calendar month supply.36
  • As it currently stands, the federal contraceptive coverage guarantee does non include vasectomy or external (male person) condoms, although these methods have proven health benefits for individuals and couples. Vasectomies are less invasive, have lower health risks and are less expensive than female sterilization. External condoms are an of import primary and fill-in method of contraception and accept the added benefit that they foreclose STIs.37,38

Data CENTER

RECENT STATE ACTION ON THIS Issue

States that have addressed this issue over the past three years are listed beneath.

Eastward: State enacted a relevant measure

5: State vetoed measure

A: State adopted measure in at least i bedchamber

States that have expanded on the contraceptive coverage guarantee in the Affordable Intendance Act

Alaska (2018)

A

Connecticut (2018)

E

Delaware (2018)

Eastward

District of Columbia (2018)

E

Hawaii (2017)

A

Maine (2017)

Due east

Massachusetts (2017)

East

Nevada (2017)

Due east

New Hampshire (2018)

E

New Mexico (2017, 2019)

A, E

New York (2018, 2019)

A, E

Oregon (2017)

E

Washington (2018)

Due east

States that allow health insurance enrollees to obtain an extended supply of contraceptives

Colorado (2017)

Eastward

Connecticut (2018)

E

Delaware (2018)

E

District of Columbia (2018)

East

Iowa (2019)

A

Maine (2017)

East

Massachusetts (2017)

E

Nevada (2017)

East

New Hampshire (2018)

E

New Jersey (2017)

East

New Mexico (2017)

A

New York (2018, 2019)

A, E

Oregon (2017)

E

Rhode Island (2018)

E

Due south Carolina (2017)

A

Virginia (2017)

E

Washington (2017)

E

States that include coverage for over-the-counter contraceptive methods without a prescription

Connecticut (2018)

Due east

Delaware (2018)

E

Commune of Columbia (2018)

Eastward

Iowa (2019)

A

Massachusetts (2017)

East

New Mexico (2017)

A

New York (2018, 2019, 2019)

A, A, E

Oregon (2017)

E

Washington (2018, 2019)

E, E

States that include vasectomy in health insurance coverage

Alaska (2018)

A

Hawaii (2018)

A

New Mexico (2017)

A

New York (2018, 2019)

A

Oregon (2017)

E

Washington (2018)

E

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18. Gariepy AM et al., The impact of out-of-pocket expense on IUD utilization among women with private insurance, Contraception, 2011, 84(6):e39–e42, http://world wide web.contraceptionjournal.org/article/S0010-7824(11)00432-X/fulltext.

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22. Bearak JM and Jones RK, Did contraceptive use patterns change subsequently the Affordable Care Act?: A descriptive analysis, Women's Health Issues, 2017, 27(three):316–321, http://world wide web.whijournal.com/commodity/S1049-3867(17)30029-4/fulltext.

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24. Sonfield A et al., Touch on of the federal contraceptive coverage guarantee on out-of-pocket payments for contraceptives: 2014 update, Contraception, 2015, 91(i):44–48.

25. NWLC, New data estimates 57.six meg women have coverage of birth control without out-of-pocket costs, 2017, https://nwlc.org/wp-content/uploads/2017/09/New-Preventive-Services-Estimates-2.pdf.

26. Step LE, Dusetzina SB and Keating NL, Early impact of the Affordable Intendance Act on oral contraceptive cost sharing, discontinuation, and nonadherence, Health Affairs, 2016, 35(9):1616–1624, http://content.healthaffairs.org/content/35/9/1616.short.

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28. Canestaro W et al., Implications of employer coverage of contraception: cost‐effectiveness analysis of contraception coverage under an employer mandate, Contraception, 2017, 95(1):77–89.

29. NWLC, Land of Birth Command Coverage: Health Plan Violations of the Affordable Care Human action, 2015, https://nwlc.org/resource/state-birth-control-coverage-health-plan-violations-affordable-care-human action/.

thirty. Sobel L, Salganicoff A and Kurani N, Coverage of Contraceptive Services: A Review of Health Insurance Plans in Five States, KFF, 2015, http://kff.org/private-insurance/report/coverage-of-contraceptive-services-a-review-of-health-insurance-plans-in-five-states/.

31. U.Due south. Department of Labor, Frequently Asked Questions About Affordable Care Act Implementation (Part XII), 2013, http://www.dol.gov/sites/default/files/ebsa/near-ebsa/our-activities/resource-centre/faqs/aca-part-xii.pdf.

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34. Barot S, Moving oral contraceptives to over-the-counter condition: policy versus politics, Guttmacher Policy Review, 2015, 18(4):85–91, https://www.guttmacher.org/about/gpr/2015/11/moving-oral-contraceptives-over-counter-status-policy-versus-politics.

35. White KO and Westhoff C, The effect of pack supply on oral contraceptive pill continuation: a randomized controlled trial, Obstetrics & Gynecology, 2011, 118(iii):615–622.

36. Foster DG et al., Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies, Obstetrics & Gynecology, 2011, 117(3):566–572.

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38. Sonfield A, Rounding out the contraceptive coverage guarantee: why 'male' contraceptive methods matter for everyone, Guttmacher Policy Review, 2015, 18(ii):34–39, https://world wide web.guttmacher.org/well-nigh/gpr/2015/06/rounding-out-contraceptive-coverage-guarantee-why-male person-contraceptive-methods.