Feds to Insurance Companies: You Actually Have to Cover Birth Control

Three federal agencies issued a pointed set of “clarifications” Monday, basically reminding health insurance companies that under the Affordable Care Act, they really do have to cover birth control without a co-pay or deductible. No, seriously. The same goes for “well woman” exams, preventive services for transgender people and numerous other things insurers have squirreling their way out of paying since the ACA passed.

The new “clarifying guidance” was issued by the Department of Labor, the Department of Health and Human Services and the Treasury Department and it’s pretty goddamn clear: on contraceptives, insurers must cover “without cost sharing” (meaning no co-pays, no deductibles, no cost whatsoever), “at least one form of contraception in each of the methods (currently 18) that the FDA has identified for women in its current Birth Control Guide.” The coverage also has to extend to “clinical services, including patient education and counseling, needed for provision of the contraceptive method.”

Just in case that wasn’t quite clear, the birth control guide issued by the FDA, which you can read right here, shows each of those 18 birth control methods, which include the pill, shot, ring, sterilization, male and female condoms, and even spermicide.

Health insurers can still use what the HHS calls “reasonable medical management techniques” to encourage patients to use specific contraceptives within a certain category. But they have to make those management techniques user-friendly, or what the new guidelines call an “easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider.” And if a medical provider recommends a specific service or type of birth control and deems it medically necessary, the document adds, “the plan or issuer must cover that service or item without cost sharing.” In other words, an insurance company has to defer to a doctor when making choices about what birth control method is right for a particular patient.

The guidelines also address insurer discrimination against transgender people, making it clear that they can’t charge higher co-pays or deductibles or refuse coverage based on someone’s “sex assigned at birth, gender identity, or recorded gender.” Here, again, preventive services have to be covered based on what a person who went to medical school says. The example used here is a trans man with residual breast tissue who might need a mammogram:

Where an attending provider determines that a recommended preventive service is medically appropriate for the individual – such as, for example, providing a mammogram or pap smear for a transgender man who has residual breast tissue or an intact cervix – and the individual otherwise satisfies the criteria in the relevant recommendation or guideline as well as all other applicable coverage requirements, the plan or issuer must provide coverage for the recommended preventive service, without cost sharing, regardless of sex assigned at birth, gender identity, or gender of the individual otherwise recorded by the plan or issuer.

All of this seems pretty, pretty, pretty clear, but insurance companies have a God-given talent for exploiting loopholes, and they’ll doubtless continue to do so. (The one major exception here is grandfathered health plans, which aren’t subject to any of the ACA rules.) But at least the new guidelines let patients and medical providers know what their rights are. Planned Parenthood’s CEO Cecile Richards issued an effusive statement, thanking the Obama administration for clarifying the law, calling it “a victory for women and the more than 30,000 Planned Parenthood supporters who spoke out to ensure all women, no matter what insurance they have, can access the full range of birth control methods without a copay or other barriers.” In theory.

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