In a move that could significantly improve access to contraceptives for millions of women, the U.S. Department of Health and Human Services (DHHS) on Monday announced that it is adopting in full the recommendations for women’s preventive health care the Institute of Medicine (IOM) issued in July. The services recommended by the IOM, including contraceptive counseling and provision of all methods approved by the Food and Drug Administration, will be covered without out-of-pocket costs to patients by new private health plans written on or after August 1, 2012.
Making contraceptive counseling, services and supplies—including long-acting, reversible methods (the IUD and the implant), which have high up-front costs—more affordable addresses the fact that cost can be a daunting barrier to effective contraceptive use. Removing that barrier for women covered by private health plans not only makes it easier for them to use contraception generally, but will also allow them to use the most effective methods, which they might not previously have been able to afford.
The evidence strongly suggests that insurance coverage of contraceptive services and supplies without cost-sharing is a low-cost—or even cost-saving—means of helping women overcome barriers to effective contraceptive use. The IOM recommendations fill important gaps in three existing sets of services that are already covered without cost-sharing under a provision of the 2010 health reform legislation. Developed after an exhaustive review of the scientific evidence, the recommendations also include coverage for an annual well-woman preventive care visit, specific services for pregnant women and nursing mothers, and counseling and screening services related to HIV and other STIs, cervical cancer and domestic violence.
Government bodies and private-sector experts have long recognized contraceptive services as a vital and effective component of preventive and public health care. A strong body of research shows that contraceptive use helps women avoid unintended pregnancy and improve birth spacing, resulting in substantial benefits for the health and well-being of women, infants, families and society.
However, while endorsing the IOM recommendations in full, DHHS also included an exemption that makes it possible for religious employers to opt out of the contraceptive coverage provision. Such an exemption was not required by the health care reform law and could potentially inhibit some women’s access to the contraceptive services and supplies on which they rely to prevent unintended pregnancy. Special care must be taken in implementing this exemption to mitigate any harmful impact on women who are affected.
Moreover, not all plans would be affected by the preventive services requirement—at least, not in the short run. Existing plans are “grandfathered”—meaning they are exempt from the requirement—so long as no significant negative changes, such as cutting benefits or raising cost-sharing, are made to them. DHHS has said that most plans will likely lose grandfathered status within a few years.
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