Last week, Sen. Bernie Sanders, R-Vermont, chairman of the Senate Health Committee, called on a government watchdog to investigate why insurance companies are still charging women for contraception, a move that has put access to contraception back in the spotlight.
In a letter to the Government Accountability Office, the senators noted that insurance companies are charging people for contraception that should be free under federal law and are denying consumer lawsuits seeking coverage for contraception — a practice that some experts estimate could affect access to birth control for millions of women.
Since 2012, the Affordable Care Act has required private insurance plans to cover the “full range” of female contraceptives approved by the Food and Drug Administration, including female sterilization procedures, emergency contraception, and new FDA-approved products. The mandate also covers services related to contraceptives, such as counseling, insertion or removal, and follow-up care.
This means that consumers should not have to make any co-payments with in-network providers, even if they don't meet their deductible. While some plans may only cover generic versions of certain contraceptives, patients are entitled to coverage for specific products that providers deem medically necessary. Medicaid plans have similar provisions. The only exceptions to this mandate are employer- or university-sponsored plans that object for religious or moral reasons.
But many insurance companies still charge for contraceptives, some in the form of co-payments, while others refuse coverage altogether.
A quarter of women are paying unnecessary money for contraception
In his letter, Senator Sanders cited a recent survey by the nonprofit health policy research institute KFF, which found that about 25% of women with private insurance said they paid at least part of the cost of contraception, 16% said their insurance covered them partially, and 6% said they didn't cover contraception at all. Additionally, a 2022 congressional study analyzing 68 health plans found that the process of applying for an exception to get contraception covered was “cumbersome” for consumers, with insurers denying an average of more than 40% of exception requests.
Health Insurance Provider Advocates, a national lobbying group representing insurers, said in a response letter sent to Congress earlier this year that it “will continue to work with the Administration, Congress and policymakers to ensure consumers have lawful and affordable access to contraception.”
Although federal mandates have been in place for more than a decade, companies continue to circumvent the law because “these mandates are rarely enforced and the penalties for ignoring them are relatively light,” said Anna Barr, a spokeswoman for Sen. Sanders. Whenever companies are penalized, they find another way to deny coverage, she said.
In 2015, a study by the National Women's Law Center, a nonprofit legal organization, found that insurers claimed they didn't cover the hormonal ring, intrauterine device, or patch because they covered other hormonal methods of birth control. The practice was a violation of mandates, and the Obama administration cracked down on it.
Today, consumer complaints are a bit different, said Gretchen Borchelt, vice president of reproductive rights and health at the law center. The organization is hearing from women whose plans come with “try and fail” provisions, which mean patients can't try their preferred method or those recommended by their health care provider until they try and “fail” a particular product, usually oral contraceptives.
Earlier this year, the Department of Labor, one of three government agencies charged with enforcing the Affordable Care Act, called the practice “problematic.”
Alina Salgannikov, senior vice president and director of women's health policy at KFF, said insurers frequently refuse to cover new contraceptives that have been approved by the FDA. Insurers also sometimes cover contraceptives like IUDs but not related services like insertion and removal, she said. The percentage of privately insured women who don't pay anything for IUDs or implants has declined since 2015, according to a study released last summer.
What to do if you're charged for birth control
Salgannikov says he speaks to both doctors and insurance companies, reminding them that by law they don't have to pay.
You can also call the National Women's Law Center's hotline, which will help you thoroughly review your plan and figure out what's wrong, Borchelt says. The hotline can also help patients get reimbursed.
Consumers should also let officials know, as such complaints are often investigated, she said.
In Vermont, consumer complaints led to a two-year investigation into health insurance plans that found about 9,000 people had been improperly charged for contraceptives, leading the state to order insurers to pay $1.5 million in refunds last year.
“Public pressure goes a long way,” Borchelt said.