Obama Admin Puts Insurance Co on notice: Must cover all forms of Contraceptives under ACA

May 13, 2015

Insurance companies across the nation have been required to have policies that meet ACA standards and to follow the law in terms in of providing benefits and coverages since January 1, 2014. However, six months after the law was passed (Sept 23, 2010), the Preventative benefits kicked in. While some of the benefits that kicked in at this time applied to all policies, both Grandfathered and non-grandfathered plans, the Preventative benefits were only required to be offered on non-grandfathered plans. Many of these non-grandfathered plans were converted to an ACA policy on 1/1/14, and a few still remain in force due to the extension offered under the transition relief ....some will remember Pres. Obama getting on the news when the first Open enrollment was under way in the fall of 2013 and the marketplace website kept crashing. He was quoted as saying "I think you should be able to keep your policy." Thus the transitional relief! ...people can keep their non-grandfathered plans another year but will eventually be force to convert to an ACA plan.

The Preventative services covered under the Affordable Care Act include a list of services for adults, women, and children. This list of preventative services must be covered without the insured having to pay a co-payment, co-insurance, or a deductible. In other words: FREE. The insurance company or Dr.'s office cannot impose even as much as a $10 or $20 Dr. copay. The list includes annual physicals, flu shots, paps smears and mammograms for women, and various cancer screening (ie colonoscopy) and tests for other diseases and conditions like diabetes and high blood pressure, as well as all the normal well-baby checkups. The federal guidelines do specify in some cases when these service will be covered and how often. For example, a baseline mammogram is covered annually starting at age 40; colonoscopy is covered for adults age 50 and over.

In the fall of 2011, the head of HHS (Kathleen Sebelius) announced that she was adding a number of women's services to this preventative list, following recommendations from the National Academy of Sciences. The list will include all forms of contraception, counseling on how to avoid sexually transmitted diseases and other services such as services for women of domestic violence, and items for new mothers, like breast pumps. This caused many religious groups to be up in arms (most of them opposed to the free birth control), but the law did include a provision that would allow religious institutions to opt out of offering birth control coverage. This new coverage for Birth Control and other women services went into effect in Sept 2012.

So fast forward to May 2015....the Obama Administration is learning that many carriers across the country and NOT complying with the law. An independent study from the Kaiser Foundation found 5 out of 20 insurance carriers non-compliant with the law, charging co-pays and in some cases not covering certain forms of birth control. A separate report from the National Women's Law Center found problems with coverage of the vaginal ring, the patch and an intrauterine device (IUD). The Food and Drug Administration "currently identifies 18 distinct methods of contraception for women,"" the administration said. insurers have to cover one of each of the 18 types for free. however, they can still take steps like charging patients for more expensive brand-name versions instead of generics. (NYTimes article.ins cos ordered to heed law and cover birth control.)

The 18 types of contraception are:

  • Sterilization surgery
  • Surgical sterilization implant
  • Implantable rod
  • Copper intrauterine device
  • IUDs with progestin (a hormone)
  • Shot/injection
  • Oral contraceptives (the pill), with estrogen and progestin
  • Oral contraceptives with progestin only
  • Oral contraceptives, known as extended or continuous use that delay menstruation
  • The patch
  • Vaginal contraceptive ring
  • Diaphragm
  • Sponge
  • Cervical cap
  • Female condom
  • Spermicide
  • Emergency contraception (Plan B/morning-after pill)
  • Emergency contraception (a different pill called Ella)