All state-regulated health plans must provide additional coverage for certain reproductive health services and access to birth control. The Affordable Care Act requires insurers to provide free coverage for all federal Food and Drug Administration (FDA)-approved prescription contraceptives as part of preventive services (www.healthcare.gov). State law requires this and now additional benefits, including:
- Coverage for all FDA-approved, over-the-counter contraceptives with no cost sharing, including condoms, spermicides, emergency contraceptives and sponges.
- Contraceptives on your plan's drug list (also called formulary) must be covered if your plan uses a formulary for other covered prescriptions.
- All medical services associated with prescribing, dispensing, delivering, distributing, administering and removing prescription contraceptives are covered just as other outpatient services are covered.
- Coverage for voluntary sterilization and vasectomies with no cost sharing.
- If you get your coverage from certain religious employers, your plan may provide contraception through a special accommodation.
- If a health plan covers maternity services, it must provide coverage for abortion services.
- Student health plans issued or renewed after Jan. 1, 2022 must provide coverage for abortion services if it also provides maternity care and services.
No cost sharing for birth control
Health plans cannot require copays or deductibles for prescription contraceptives when they're provided by an in-network pharmacy or provider, unless you have an Health Savings Account (HSA) plan. If you have an HSA, your plan may apply a deductible for over-the-counter contraceptive supplies or services, but it cannot be more than the minimum deductible for a HSA-qualified plan, which is $1,400 per individual.
Individual/family and certain group health plans in Washington state are required to cover a 12-month refill of birth control pills rather than 12 separate 30-day refills (leg.wa.gov). The prescriptions are provided to consumers at no cost. That means you will receive a 12-month supply of birth control pills in one visit to the pharmacy without paying out of pocket. However, you can request a smaller supply. Your doctor can also prescribe a smaller amount if needed.
Know your rights
Your health plan must provide these and other reproductive benefits to you and cannot:
- Require a prescription for over-the-counter contraceptive drugs, devices, and products approved by the FDA.
- Charge a copayment or coinsurance for an FDA-approved contraceptive method.
- Limit you to certain contraceptives, such as generics only, without allowing you to ask for a waiver if your provider says your preferred contraceptive is medically appropriate.
- Deny coverage of contraceptives supplies or services because you changed contraceptive methods within a twelve-month period.
- Impose an unnecessary burden, restrictions or delays on required coverage of contraceptive services and supplies due to medical management techniques.
- Restrict, exclude or reduce coverage or benefits on the basis of gender.
- Limit your choice in accessing the full range of contraceptive drugs, devices or other products approved by the FDA.
If you believe you've been wrongly denied this coverage, file a complaint and we will investigate.
See additional health benefits for women.
If you have a grandfathered plan
Grandfathered plans not covered by health reform may require you to pay copayments, deductibles and coinsurance for prescription contraceptives and associated services, just as you would for other prescription drugs, devices or services.