Some insurance plans still aren’t complying with the Affordable Care Act. Here’s what to do if you’re getting charged at the pharmacy.
You probably know that birth control is free without a copay under the Affordable Care Act (ACA).
And if you didn't...surprise! Now you know. The ACA went into effect back in August 2012, and one of the benefits is that all FDA-approved birth control methods are covered without a copay as long as you have insurance. This applies to you if you get your plan through the Health Insurance Marketplace or if you get your plan through your employer. This should also apply to anyone on Medicaid, but full coverage may vary from state to state. The only exceptions to the rule are religious exemptions and grandfathered plans (ones that haven't been updated in a while) — but more on those later.
For most people, this benefit didn't kick in immediately — you may have had to wait until you renewed your plan or until your company changed their plan. But by now, the majority of people should be receiving this benefit, Mara Gandal-Powers, senior counsel in health and reproductive rights for National Women's Law Center (NWLC), tells BuzzFeed Life.
And it's not just free birth control — this benefit also covers the doctor's appointments to get birth control, any insertion or removal costs for long-acting methods, and any counseling or follow-up visits relating to your birth control. So if the sole reason for your doctor's office visit is birth control-related, you shouldn't be charged a copay for that visit, says Gandal-Powers.
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But some people are still getting charged for their birth control when they should be getting it for free.
A new report from NWLC found that some plans are still not complying with the ACA. They run a website and hotline called CoverHer, which assists women who are having trouble getting their birth control coverage. Since August 2012, nearly 2,800 people have contacted them for help. For this review, they went over all those interactions, plus documents from 100 insurance plans in 15 states.
Here's what they found: Some plans aren't covering all FDA-approved methods or they're charging copays for them, some plans are only covering generic birth control, and some plans aren't covering doctor's visits or counseling associated with birth control. Under the Affordable Care Act, that's illegal.
1. Find out if you’re on a grandfathered plan.
This means that your insurance plan hasn't gone through any major updates or changes since the ACA went into effect. To find out, call up your insurance and ask, "Am I on a grandfathered plan?" They'll know what that means. Grandfathered plans are not required to cover birth control without a copay, but they might still cover some methods for free.
Even if you JUST signed on to a new plan (like if you changed jobs or enrolled in a new plan recently), it's still possible that you're in a grandfathered plan. That's because grandfathered plans can still enroll new people. They only become "un-grandfathered" if they change in a way that substantially cuts benefits or increases costs for consumers, according to Healthcare.gov. With each year, there are a fewer and fewer grandfathered plans, but it's still possible that you might have one.
How To Get Birth Control For Free: Some grandfathered plans actually do offer some birth control methods at no cost, so call your insurance company to see what options are available, says Gandal-Powers. Then find out when your next open enrollment is, since that's when most grandfathered plans will change.