August 20, 2015

A Review of Private Insurance Coverage of Contraception in Five States

The federal Affordable Care Act requires most private health insurance plans to cover, without cost-sharing, all prescribed Food and Drug Administration (FDA)-approved contraceptive supplies and services. Federal guidance allows plans to apply reasonable medical management (RMM) techniques to control costs and promote efficient care.

A recent Kaiser Family Foundation article reviewed coverage in five states (California, Georgia, Michigan, New Jersey, and Texas). Researchers evaluated 20 different insurance carriers’ coverage policies for 12 prescribed contraceptive methods (excluding oral contraceptives) to determine how they applied RMM techniques.

According to the article, plans varied in how they interpreted and implemented the contraceptive coverage requirement. Specifically, researchers found a higher number of plans limited certain contraceptive methods. For example, health carriers were least likely to cover the NuvaRing (a vaginal ring), with only 12 out of 20 providing coverage without cost sharing or RMM limitations. As another example, while most carriers covered the Plan B emergency contraceptive (EC) pill, only 11 carriers covered the ella EC, which is effective longer and preferable for women with a higher body mass index.

Additionally, researchers found that none of the carriers established a formal process for beneficiaries to contest coverage limitations on preventive services. They were also unable to confirm whether carriers had an expedited appeal process that would allow women timely access to emergency contraceptives not covered under their policies.

Click here to access the full report.