The Myth of Free Birth Control
My Nexplanon Nightmare
The Affordable Care Act was designed to guarantee women access to birth control without out-of-pocket costs, regardless of their insurance plan. In practice, as my recent experience in New York City demonstrates, the reality is far more complicated and frustrating.
The Runaround Begins
I have used Nexplanon for several years. It’s a long-acting reversible contraceptive that is over 99 percent effective and is implanted into the upper arm. I chose this option because it’s a “set it and forget it” type of birth control. I had heard that getting a vaginal IUD can be extremely painful (so much so that the leading industry group for gynecologists now recommends local anesthetics), and condoms and oral pills are only 87 and 93 percent effective, respectively, when accounting for user error.
I had my most recent Nexplanon inserted in February 2019. According to both the Nexplanon and FDA websites, the device is effective for up to three years. So, I went to get it replaced in February 2022. At the OB/GYN office, I was told that the device is actually effective for up to five years. I confirmed this with Planned Parenthood’s free chat service. My OB/GYN speculated that the discrepancy might be a tactic by Nexplanon’s parent company, Merck, to boost sales.
Deductible Drama
This year, I used Zocdoc to find an in-network OB/GYN to replace my Nexplanon. I scheduled an appointment with the same OB/GYN who had performed my annual well-woman visit. Despite attempting to address the replacement during that visit in October, they lacked the necessary device and asked me to return in two weeks. When I voiced my concerns about committing to a five-year device, the OB/GYN advised against unplanned pregnancies and left before we could discuss my options.
On the day of the appointment, I was anxious about the procedure and hesitant to bring my husband for support, fearing it might seem excessive. More significantly, choosing to replace my Nexplanon felt like a definitive step away from having biological children. At 32, with the device effective for five years, I felt I was making a permanent decision about my future.
The Cost Confusion
When I checked in, the receptionist informed me of a $150 co-pay.
“What? Isn’t birth control supposed to be free?” I asked.
“You have a high deductible plan,” she replied. This led to further complications. I am self-employed and purchase health insurance through state exchanges, paying $618.92 a month for a Bronze plan with MetroPlus Health. My plan has a $4,600 deductible and a $9,450 maximum out-of-pocket, and it has not covered any healthcare costs since I enrolled.
“I understand, but my deductible shouldn’t affect this. All plans, especially those on state exchanges, are required to cover birth control,” I countered. Wasn’t that a core provision of the ACA?
“I don’t know. You can call your insurance company. All I know is we’re charging you $150 today. Or I can cancel the appointment,” she said.
Frustrated, I decided to cancel. “I’ll cancel the appointment. Thank you.”
“Consider contacting Planned Parenthood,” she suggested.
“Thanks,” I said, turning to my husband. “Let’s go.”
When we got home, we called Planned Parenthood. The representative said we could schedule an appointment, but she couldn’t provide the cost. Someone would call us back with the information, though she couldn’t say when. We would just have to wait for the call.
Insurance Coverage Confusion
According to my insurance plan documents:
“We cover family planning services, including FDA-approved contraceptive methods, patient education and counseling, and device insertion and removal. These services are not subject to copayments, deductibles, or coinsurance.”
I called MetroPlus Health and, after 20 minutes on hold, explained the situation. The representative confirmed that the device should be covered but couldn’t clarify coverage for removal or replacement.
“I can’t remove it myself,” I said. “If you don’t know if the procedure is covered, who should I talk to?”
“Let me check for providers fully covered by your plan,” the representative said.
After a while, I was told there was only one in-network family planning provider listed. I called the recommended New York Health and Hospitals number and, after long wait times and being passed around, learned that the OB/GYN wasn’t accepting new patients.
Finding a Provider
Eventually, MetroPlus Health referred me to a federally qualified health center where I saw a women’s health nurse practitioner (NP). While NPs provide valuable care, they have less training compared to OB/GYNs. NPs complete 500–1,000 clinical hours, while OB/GYNs complete over 10,000. Despite this, I had to wait six weeks for an appointment and was charged the full $75 specialist co-pay.
At the appointment, I was told that the $1,200 Nexplanon device needed insurance approval before the procedure could be performed. I had to fill out a form and wait for an insurance call to confirm the order. The NP assured me I was still protected, but I felt uneasy about the process.
When scheduling a follow-up appointment, I was told the next available slot was five weeks away. I asked if I would need to pay the $75 copay again and received an uncertain response.
The Final Hurdle
On August 28, the pharmacy confirmed that my insurance had approved the order and scheduled delivery for the following morning. Despite initial confusion at the office, the device arrived on time, and I was able to have my Nexplanon replaced successfully.
Conclusion: A Call to Action
After ten months, four visits, numerous phone calls, and $75, I finally had effective birth control. Unfortunately, my experience is not unique. According to the Kaiser Family Foundation, one in five women (18%) are not using their preferred contraceptive method, and a quarter (25%) say it’s because they can’t afford it. Additionally, 21% of women with private insurance still pay out-of-pocket costs for contraceptive care.
As we continue to fight for reproductive rights in a post-Roe America, we must address these critical gaps in contraceptive access. The promise of free birth control remains unfulfilled for too many women. It’s time for systemic change to ensure that the right to accessible and affordable birth control becomes a reality for everyone. Advocate for better contraceptive access, support reproductive rights organizations, and push for reforms to bridge these gaps in care.
