For Consumers

Reproductive health benefits

As of Jan. 1, 2019, all state-regulated health plans must provide additional coverage for certain reproductive health services. The Affordable Care Act requires insurers to provide free coverage for all federal Food and Drug Administration (FDA)-approved prescription contraceptives. Starting next year, state law requires this and additional benefits, including:

  • Coverage for All FDA-approved, over-the-counter contraceptives with no cost sharing, including condoms, spermicides, emergency contraceptives, and sponges;
  • Coverage for voluntary sterilization and vasectomies with no cost sharing; and
  • If a health plan covers maternity services, it must provide coverage for abortion services.

No cost sharing

Health plans cannot require copays or deductibles when services are 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 $1,350 per individual.

Know your rights

Your health plan must provide these reproductive benefits to you and cannot: 

  • Require a prescription for over-the-counter contraceptive drugs, devices, and products approved by the FDA.
  • 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.