by Austin Montoya, Social Media and Online Coordinator
Perhaps one of the best-known and certainly most controversial requirements of the Affordable Care Act (ACA) is that insurers must cover contraceptives at no cost to the consumer. But, whether intentionally or not, some insurers were still denying women access to some forms of birth control and other preventive services. The White House and the Department of Health and Human Services (HHS) have now issued guidance clarifying these preventive services benefits after a report on the state of women’s coverage was released by the National Women’s Law Center (NWLC). The NWLC report found that many insurance companies are charging women out-of-pocket costs (such as copays) for birth control, as well as limiting coverage options for certain types of birth control – both of which are contrary to the aim of the ACA.
In addition to the contraceptive coverage gaps, the report also found violations related to well-woman visits, prescription drug coverage, care related to gender transition for transgender individuals, chronic pain treatment, and certain pre-existing conditions. Many of these issues were identified in insurance plans in Colorado.
Thankfully, the guidance addresses most of these issues. It clarifies that insurers must cover at least one form of all 18 methods of contraception without any charge, including the ring, the patch, and intrauterine devices (IUDs). In other words, although both the pill and the ring are hormonal, plans are required to cover each form of contraception.
In addition to the birth control clarifications, the guidance also instructs insurers to cover well-woman visits and other preventative services like genetic testing and counseling for women who may be at risk for breast or ovarian cancer. Regarding transgender services, it states that insurers cannot deny coverage or charge for “sex-specific recommended preventive services” because of a person’s gender identity or the sex assigned at birth.
A press release from HHS states, “the clarification seeks to eliminate any ambiguity.”
These clarifications help break down some of the barriers women and LGBT people face and many are now going to be able to access the care they need as intended under the ACA. However, barriers still exist.
One practice known as “reasonable medical management” allows insurers to restrict access to certain medications for cheaper alternatives. The practice can be prevalent with birth control patches and rings. A study by the Kaiser Family Foundation found that some plans are limiting access to rings and patches, offering the pill as an equally effective option. Although the guidance does address this issue, saying that the insurer must prove that the management process is not “unduly burdensome” to the consumer, it is still possible that insurers will try to prevent women from getting the care that is right for them.
After the Colorado Senate killed a bill that would have extended the Family Planning Initiative, which helped provide Long-Acting Reversible Contraceptives (IUDs and implants) to low-income women, these clarifications may help close the gap that women face in accessing birth control. Colorado women who may have been wrongfully charged for their birth control may now have the opportunity to receive the method that best fits their needs, even as funding for the Family Planning Initiative ends.
This past Mother’s Day started National Women’s Health Week (NWHW) – a week dedicated to empowering women to make their health a priority. The ACA has made great strides to give women more opportunities to make healthy choices for themselves and their families. While the timing of this new guidance from HHS gives women across the country another great reason to celebrate NWHW, it also further highlights the need to do more to improve women’s health and access to health care services
If you find out your plan is not covering your preventive services, you can contact the National Women’s Law Center, your health insurance provider, or the Colorado Division of Insurance.
To learn more about you insurance and other ways to stay healthy, you can join our Twitter chat using the hashtags #NWHW and #NWHWevent on Wednesday, May 13 at 1 p.m. MST. Be sure to follow on Twitter @COHealthAccess to get NWHW updates all week!