Background

Contraception is crucial for helping women avoid unintended pregnancies, and it has myriad health, social and economic benefits. Since the mid-1990s, 28 states have required health insurance plans regulated by the state that provide coverage of prescription drugs and devices to also cover prescription contraceptives.

Federal law, under a provision of the Affordable Care Act of 2010, expanded on these state policies in several ways. The federal contraceptive coverage guarantee applies to most private health plans nationwide, whether sold to employers, schools or individuals, or whether offered by employers that self-insure. (An employer that self-insures shoulders the financial risks for health care costs for its employees. State laws cannot regulate self-insured employers, which cover about 60% of insured workers nationwide.)

In addition, the federal guarantee specifically requires coverage for 18 methods of contraception used by women (including female sterilization), along with related counseling and services, and it requires this coverage to be provided without any out-of-pocket costs to the patient, such as copayments or deductibles. The federal guarantee does not require similar coverage for vasectomy or male condoms. Under the guarantee, health plans may apply formularies, prior authorization requirements and similar restrictions within a method category (e.g., to encourage patients to choose one hormonal IUD over another), but they may not favor one type of method over another (e.g., oral contraceptives over contraceptive rings). 

More recently, some states have amended and expanded their own requirements to match the standard set in the federal guarantee, specifically requiring coverage for the full range of contraceptive methods, counseling and services used by women; eliminating out-of-pocket costs; and limiting other health plan restrictions. Some of these new state provisions go beyond the federal guarantee by requiring coverage for contraceptive methods that are available over the counter without requiring the patient to first obtain a prescription, ensuring that women may receive an extended supply of a method at one time (usually a one-year supply, rather than a typical one- or three-month supply), or requiring coverage of male sterilization without out-of-pocket costs.

In October 2017, the Trump administration made it much easier for an employer to exclude contraceptive coverage from any health plan it offers to its employees and their dependents. One regulation allows any employer—nonprofit or for-profit—to exclude some or all contraceptive methods and services from the health plans it sponsors if the employer has religious objections. Another regulation allows employers with moral objections to do the same, although it applies to a slightly narrower set of employers (any employer that is not a publicly traded company). Enforcement of these regulations has been blocked by the courts. Previous federal regulations are in effect that offer an exemption for a much narrower set of explicitly religious employers and provide an “accommodation” for other nonprofit and closely held for-profit employers with religious objections that allows them to avoid paying or arranging for contraceptive coverage while still ensuring that employees and dependents receive coverage seamlessly from the same insurance company. Most of the state laws that expand contraceptive coverage offer exemptions as well, although few of them are as broad as the blocked federal exemption.   

Highlights

Insurance Coverage of Contraceptives 

Jurisdiction

Coverage required for:

Prohibits cost sharing

Prohibits restrictions and delays

Refusal provisions

 

Prescription methods

Over-the-counter methods

Extended supply

Male sterilization

Female sterilization

Scope

Enrollees notified by:

Federal

X

X

 

 

X

X

 

Broader§

 

Arizona

X

 

 

 

 

 

 

Expansive

Employer

Arkansas

X

 

 

 

 

 

 

Broader

 

California

X

X (excludes male condoms)

X

 

X

X

X

Limited

Employer

Colorado

X

 

Ψ

 

 

 

 

 

 

Connecticut

X

 

 

 

 

 

 

Expansive*,†

Insurer

Delaware

X

X (excludes male condoms) 

 

 X

 X

Expansive

Employer

District of Columbia

 X£​

 X£​

X

 

 X£​

 X£​

X£​ 

 Expansive£​

Employer£​ 

Georgia

X

 

 

 

 

 

 

 

 

Hawaii

  XӨ

 

X

 

 

 

 

Expansive†

Employer

Illinois

X

X (excludes male condoms)

X

X

X

X

X

Almost unlimited‡

 

Iowa

X

 

 

 

 

 

 

 

 

Maine

X,Ψ

 

Ψ

 

Ψ

Ψ

 

Broader

Employer

Maryland 

X

 X (drugs only)

X

X

 

X

 

Expansive

Employer

Massachusetts

X

X (excludes male condoms)

X

 

X

 X

 

Broader

Employer

Michigan

X

 

 

 

 

 

 

Broader

 

Missouri

X

 

 

 

 

 

 

Almost unlimited†,‡

Insurer

Montana

X

 

 

 

 

 

 

 

 

Nevada

X

 X (only EC)

X

 

X

X

X

Expansive‡

Insurer

New Hampshire

X

 

 

 

 

 

 

 

 

New Jersey

X

 

 

 

 

 

 

Broader

Employer

New Mexico

X

 

 

 

 

 

 

Expansive

 

New York

X

 

X

 

 

X

 

Limited†

Employer/ insurer

North Carolina

X

 

 

 

 

 

 

Broader

Insurer

Ohio

 

 

 

 

 

 

 

 

Oregon

XӨ, Ψ

Ψ (excludes condoms) 

X

Ψ

Ψ

Ψ

Ψ

Limited

 

Rhode Island

X

 

 

 

 

 

 

Broader

Employer

TennesseeӨ

 

 

 

 

 

 

 

 

 

Texas**

 

 

 

 

 

 

 

 

 

Utah

β

 

 

 

 

 

 

 

 

Vermont

X

 

X

X

X

X

X

 

 

Virginia**

 

 

 X

 

 

 

 

 

 

Washington

X

 Ψ

X

 Ψ

 X

 X

Ψ 

 

 

West Virginia

X

 

 

 

 

 

 

Expansive†

Insurer

Wisconsin

X

 

 

 

 

 

 

 

 

TOTAL

29

7

13

3

8

10

6

21

16

Note: EC=emergency contraception.

§ Regulations that offered an almost unlimited religious and moral exemption are currently blocked by the courts.

‡ Refusal clause applies to insurers.

ᵝ The state allows pharmacists to prescribe and dispense contraceptives, but insurance coverage of these services is not explicitly included in the law.

Ψ The following states have enacted laws that will not apply to insurance plans until a later date: Colorado (January 2019), Maine (January 2019), Oregon (January 2019) and Washington (January 2019).

£​ Health plans are required to offer this coverage under a temporary law that is in place while a permanent law is under Congressional review. The permanent law is expect to apply to health plans starting in January 2019.

* Religious insurers are not exempt from the mandate but may provide contraceptive coverage through a subcontract with another insurer or third-party entity.

† Enrollees have the option of obtaining coverage directly from insurer.

** Health plans are required to offer employers the option of including coverage for contraception.

€ The state’s law allows pharmacists to dispense the full amount of a prescription at one time, including contraception, but there is no requirement that health insurance plans cover the cost of accessing a year’s worth of contraceptives at one time.

Ө The state explicitly includes coverage for contraception that is prescribed and dispensed by a pharmacist.