Answers to All Your Questions About Obamacare's Birth Control Mandate

Open enrollment for the Affordable Care Act begins October 1, a date that seems far away now that we’re in the sweaty dregs of August but will be here before you figure out how to set up your air conditioning. Obamacare should ensure that no woman goes without preventative care, including contraception and well-woman visits, because she doesn’t have the means to pay, but what does that actually mean when you’re at the doctor’s office, waiting in line at the pharmacy, or dealing with bloviating bishops and bigoted bosses who are overly concerned about how your newly insured vagina affects their close and personal relationship with Jesus?

Insured women’s health care is one of the biggest advancements in women’s health in a generation. Here are answers to some of our questions about this exciting — but often extremely fucking confusing — time in history.

When/How do I get my free birth control?

An estimated 26,947,000 U.S. women already benefit from the women’s preventive health care provision, which went into effect on August 1, 2012. When the benefit goes into full effect, approximately 47 million women nationally stand to benefit.

If you already have health insurance: your birth control might already be covered without a co-pay. (If you’ve been to the pharmacy to pick up your birth control and were shocked by a $0 receipt, that’s the new benefit in effect. Planned Parenthood has some of those receipts featured on their Pinterest page here, if you’re into that sort of thing!)

If you’re not sure whether your plan already covers birth control without a co-pay, all you have to do is call your insurance company (that number on your insurance card) — unfortunately, not all plans have to cover the benefit just yet. Your plan might not kick in for a year or more.

If you need tips on what to say when you call, click here.

If you don’t have health insurance: you can enroll in an affordable health insurance plans starting on October 1 (plans and prices aren’t available until then). These new insurance plans will have to cover preventive care, including well woman exams and a range of birth control methods without a co-pay. That means you won’t have to pay anything out of pocket for these services. Yay!

As of October 1, nearly 12 million uninsured women between the ages of 19 and 44 will become newly eligible to apply for Medicaid or qualify for premium tax credits to help purchase health insurance coverage through state marketplaces under the Affordable Care Act via the Health Insurance Marketplace. Coverage will begin on January 1, 2014. Enrollment is open through March 31, so coverage will begin later depending on when you enroll. Here’s an extensive timeline that’s pretty easy to follow.

If you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), your coverage can begin immediately. You can also apply for either of these programs right now, before open enrollment begins.

What is and isn’t covered? Exactly what birth control must be covered without a co-pay?

All Marketplace health plans and many other plans must cover this list of preventive services for women without charging a copayment or coinsurance, even if you haven’t met your yearly deductible (applies only when these services are delivered by an in-network provider):

Anemia screening on a routine basis for pregnant women
Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
Breast Cancer Mammography screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention counseling for women at higher risk
Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
Cervical Cancer screening for sexually active women
Chlamydia Infection screening for younger women and other women at higher risk
Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
Domestic and interpersonal violence screening and counseling for all women
Folic Acid supplements for women who may become pregnant
Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
Gonorrhea screening for all women at higher risk
Hepatitis B screening for pregnant women at their first prenatal visit
HIV screening and counseling for sexually active women
Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older
Osteoporosis screening for women over age 60 depending on risk factors
Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
Sexually Transmitted Infections counseling for sexually active women
Syphilis screening for all pregnant women or other women at increased risk
Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
Urinary tract or other infection screening for pregnant women
Well-woman visits to get recommended services for women under 65

Although the full range of FDA–approved prescription contraceptive drugs and devices must be covered by each insurance plan without charging you a copayment or coinsurance — the pill, the shot, the ring, implants, etc. — not every brand of every method has to be covered. When you check with your health insurance company to find out if your plan covers the new benefit yet, ask questions about the specific brands you like.

How do I ask my doctor to be mindful of my financial situation as s/he prescribes? Can I request only free birth control methods?

Again, every insurance plan must cover at least one form/brand of each method. You don’t need us to tell you that figuring out the best method for you is incredibly important. Every woman has different needs when choosing a method because we are all very special flowers/snowflakes/seashells/vulvas (?)

Knowing which brands are covered by your insurance without a co-pay is helpful information to bring with you as you have these discussions with your doctor.

If your current brand of birth control isn’t covered under your insurance plan without a co-pay, it’s worth having a conversation with your doctor to see if there is a different brand (perhaps generic) that could meet your individual health care needs.

Are any pharmacies exempt from providing birth control?

A good question, given all the shady companies fighting the contraception mandate. To date, more than 60 lawsuits have been filed by businesses and not-for-profit groups (we profiled the first 18 for-profit companies) challenging the requirement to provide birth control without a co-pay for millions of women, and it’s expected that one or more of these challenges will reach the Supreme Court as early as 2014. In addition, the House of Representatives has voted 40 times (as of Friday) to repeal the ACA. Great use of time and energy, guys!

Although birth control must be covered without a co-pay by every insurance plan, there are still laws in place in certain states that allow health care providers to refuse to provide birth control and pharmacists to deny filling a prescription. As of July 1, 2013, ten states had refusal statutes written into their state legislation that explicitly allow health care providers to refuse to provide contraception services, according to the Guttmacher Institute. There are six states with existing laws or regulations which explicitly permit pharmacists to refuse to dispense contraception — six additional states have broadly written refusal clauses that may also pertain to pharmacists.

It’s not like the government hasn’t compromised w/ religious orgs, either: under the rule, non-profit, religiously-affiliated organizations that are opposed to covering some or all forms of contraception are able to refuse coverage in their own group health plans (plans that provide coverage to their employees and employees’ dependents). In order to ensure that individuals are getting coverage of birth control at no-cost, the health issuer will directly pay for contraceptives (this is not through the religiously-affiliated organization’s group health plan, but rather from the issuer directly). This enables the religiously-affiliated employer not to pay directly for contraception the employer opposes, while still ensuring that every woman is able to access contraception at no cost.

How do I know in advance which pharmacies won’t dispense birth control under the ACA?

See answer above. If you’re not sure about your pharmacy, we recommend calling ahead of time/ looking to see if they have a big poster of the Virgin Mary up by the “family planning” section. Just kidding.

Can I still go to Planned Parenthood?

Yep; just look for Planned Parenthood as a provider when you consider a plan. (Some people don’t know that many of Planned Parenthood’s health centers take insurance, but they do.) Planned Parenthood will also provide key information about what to look for as a young person, how to know what financial help you’re eligible for and where and when to enroll on its website, which will also have a tool where visitors can type in their zip code and find out which insurance plans include PP as a provider.

What should I consider when picking an insurance plan if I’m a woman of reproductive age?

Before you compare the cost and specific benefits of plans to help you decide which one is best for you for your individual health care needs, consider:

1. How many OBGYN providers are included in the provider network? How close in proximity are they to you?