The Affordable Care Act (ACA) provides access to no-copay birth control for everyone who needs it. But getting the birth control method of choice with no-copay isn’t always the on-the-ground reality for patients. Some of the barriers include insurance plans denying coverage even after a health care provider communicates the necessity of a particular brand name or type of birth control, requiring people to “fail first” meaning use non-preferred methods of birth control or other health services prior to approving a preferred contraceptive method, and not providing a clear and easily accessible way to get insurance coverage when a specific method of birth control is needed, such as a prior authorization.
On January 10, 2022, the Biden-Harris administration issued guidance to ensure insurance plans cover the specific method of birth control people need, without co-pays or deductibles. Depending on how people get their insurance coverage, health care providers can direct patients to hotlines and online resources to report insurance companies and plans that are not covering birth control as required.
The process to make a report may feel overwhelming for individuals, so support from a health care provider can make a difference. And the more that these hotlines hear from people struggling to get their no-copay birth control, the better the understanding the government will have of with the scope of the issues to be addressed.
If patients have private sector, employer-sponsored health insurance plans
Department of Labor
Website: askebsa.dol.gov
Hotline: 1-866-444-3272 (toll free)
Reports can be made in English and Spanish. For step-by-step directions, including screenshots, check out this blog from Power to Decide.
If patients have non-federal, public sector employer-sponsored plans
Such as people who use state and local government employee plans
US Center for Consumer Information and Insurance Oversight's Health Insurance Assistance Team
Email: phig@cms.hhs.gov
Hotline: 1-888-393-2789 (toll free)
Additional resource for patients
Anyone who is struggling to get access to no-copay contraception or other covered health services, regardless of their insurance provider, should also contact The National Women’s Law Center’s CoverHer project for help getting coverage.
