The First Anniversary of Obamacare's Free Birth-Control Policy - And Why Some Women Still Aren't Receiving the Benefit
Just over one year ago, Obamacare made contraceptive services available to women at no out-of-pocket cost, thanks in large part to your hard work. Under the new health-care law, prescription birth control, mammograms, STI counseling and treatment, and other services are now available without a co-pay. This is huge. Because over half of women 18-34 have struggled to afford prescription birth control, ensuring access to affordable birth control marks the greatest advancement for women's health in a generation. And already it's helped more than 27 million women. But even as we celebrate the benefit's first anniversary, many women are still footing the bill for their birth control. And they want to know why.If this has happened to you, you're not alone. Since the birth-control policy first went into effect on August 1, 2012, women's health advocates have heard similar stories--those of women facing co-pays at the pharmacy counter and insurance companies falling short of delivering on the law's full promise.
Here's what we know and what you can do if this is happening to you:
First, remember that Obamacare requires that all "new" health plans must comply with the contraceptive coverage requirement. "New" means plans that were created or purchased after Obamacare was enacted. Old plans--called "grandfathered" plans--don't have to comply. But keep in mind that "grandfathered" plans won't be grandfathered forever--if they change their plans in a substantial way, they lose that status. In fact, we expect 90% of grandfathered plans to lose their status in the next year or so, at which point they will be required to comply and provide birth control without a co-pay. So if your plan is grandfathered, that might be the reason you're still being charged a co-pay. Ask your benefits administrator if your health plan is grandfathered.
But if you're being charged a co-pay, it could also be because your insurance company believes that Obamacare allows it to pick and choose the contraceptives they cover cost-free. They have some wiggle room, to be sure. But even so, the birth-control policy is stronger than some companies think it is. Here's the skinny.
Some insurance companies are interpreting a section of the law
that lets them control costs to also allow them to charge a co-pay for some
forms of birth control but not others. This is why some women are being told
that they can't get the Nuva Ring without co-pay, or that only generics are
covered without a co-pay. Our allies raised concerns about this, and here's
what the government said in reply:
- Your insurance company can charge you a co-pay for a name-brand contraceptive, but only if there's also a generic version available. If there isn't a generic version, they have to cover the name-brand drug without a co-pay.
- And if your doctor determines that the name-brand drug is "medically appropriate" for you, then your insurance company must provide a waiver process that will let you get your name-brand birth control without a co-pay (see question 14 of the FAQs: http://www.dol.gov/ebsa/faqs/faq-aca12.html). (Keep in mind, this is different than the typical appeal consumers file when they're denied coverage for a service.)
If you're one of the women experiencing problems here, head over
to the National Women's Law Center (NWLC) website--they've built a toolkit to help you fight
for the coverage Obamacare says you should have. Its got answers to the
questions women are asking, a fantastic script to use when you call your
insurance company for answers, and sample letters to send your insurance
company if they charge a co-pay for your specific type of birth control.
The bottom line is, don't give up! It may take some work, but we fought too hard for birth-control coverage to give up easily! Not only that, but the work you do to educate your insurance company could make all the difference in the world for other women in your plan who may be missing out on the birth-control benefit.