Paying for the IUD under the ACA

Regardless of your opinion on the Affordable Care Act (AKA Obamacare), there is one part of the health insurance overhaul that has undoubtedly been successful: its birth control policy. The number of women who have to pay out-of-pocket costs for birth control is the lowest it’s been in recent history, and it’s all thanks to specific mandates within the Affordable Care Act. Just look at the chart below to see how wide-spread the results are:

Photocredit: Guttmacher Institute

According to Obamacare, plans on the Health Insurance Market “must cover contraceptive methods and counseling for all women, as prescribed by a health care provider…without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible.”

There’s a lot to unpack there, but the main gist is, thanks to Obamacare, you should pay nothing for birth control if you:

  • have health insurance (there are a few exceptions noted below)
  • get a prescription from your doctor
  • choose one of the 18 FDA-approved types of birth control or a generic version of it (as we’ll explain later, insurance companies can choose which brand they cover within these types).
  • find a birth control provider that’s “in” your insurance company’s network

Exceptions

Like with any law, there are exceptions. The most important to note is that Obamacare only covers female contraception. Sorry, but don’t expect to roll into CVS and walk out with a free box of Trojans.

Moreover, there are certain healthcare plans that are exempt from providing free birth control. These include:

  1. Plans purchase before March 23, 2010 (i.e. “Grandfathered plans”)
  2. Religious-employer plans (actually a huge lawsuit about it here)
  3. Short Term healthcare plans

Next, insurance companies can choose which brand of contraception to cover. They’re only mandated to cover at least one brand within each of the 18 FDA-approved categories mentioned above. So if you prefer one brand-name and your insurance provider prefers the other, you may have a copayment. Or, similarly, if you choose a brand-name drug when a generic version is available, your provider can still charge you. IT IS THEREFORE IMPERATIVE TO:

  • KNOW WHICH BRANDS YOUR INSURANCE COVERS
  • AND MAKE SURE YOUR DOCTOR KNOWS THOSE BRANDS BEFORE HE/SHE GIVES YOU A PRESCRIPTION!

If you overlook this, you might find yourself with an unexpected copayment. Read this article to see how this happens all too often.

Moving on, if you have an HMO, PPO, or POS plan (you’ll know if you do), then any procedures involved with obtaining birth control must be performed in-network to avoid any fees. For example, IUD insertions must be performed in-network if you want to get it for free. (Only if there are no available in-network doctors who perform the procedure can the cost be waived).

Finally, abortions and abortion-inducing drugs are not covered by Obamacare.

Costs of the IUD without Insurance

If you do not have health insurance, the costs of an IUD will vary by brand, your income level, and the clinic you purchase it from. If you have a higher income than average and you want to simply pay everything out-of-pocket, then:

  • Paragard will cost between $500–932
  • Mirena will cost between $500–927
  • Skyla will cost between $650–780
  • Liletta will cost between $50–750
  • Kyleena will cost between $500–900 (Kyleena is still new, but the price should be very similar to Mirena’s)

There are also programs and financial aid packages available for low-income earners without insurance. Or you can find a free/low-cost clinic like Planned Parenthood. Visit this page for specific programs.

Insertion Procedure Costs

The insertion procedure cost is separate from the device itself, and usually ranges from $150–250. If you have insurance, this should be covered as well. But definitely check with your provider to confirm this.

If you do not have insurance, again, there are free/low-cost clinics and financial assistance programs available.

So what happens if Obamacare goes away?

Needless to say, should Obamacare fail or be revoked, you can expect to see birth control costs go back up. Consider this graph:

Photocredit: Nora V. Becker and Daniel Polsky, Women Saw Large Decrease In Out-Of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing, doi: 10.1377/hlthaff.2015.0127Health Affairs 34, no.7 (2015):1204–1211

For the IUD specifically, out-of-pocket costs might shoot back up to $300–350. This would lower availability to all but the highest income-earners. Obviously, we don’t want that to happen.

Unfortunately, with the appointment of Representative Tom Price as the head of Health and Human Services (the department that controls Obamacare), a repeal is more likely than not. In fact, Rep. Price has specifically attacked the contraceptive mandate imposed by Obamacare, saying it tramples on religious freedoms in our country. Whether you agree with that or not, repealing the contraceptive mandate would put affordable birth control beyond the reach of millions of women.

Perhaps, as we suggest in this article, now would be a good time to get a long-acting reversible contraceptive like the IUD or Implant, which would protect you beyond Trump’s presidential term.

Sources:

http://obamacarefacts.com/obamacare-birth-control/

http://www.webmd.com/health-insurance/aca-birth-control-coverage-faq

http://www.parenting.com/article/what-contraception-does-obamacare-cover