Background

Contraception is crucial for helping women to avoid unintended pregnancies, and it has myriad health, social and economic benefits for women and families. 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, which applies to most private health plans nationwide, 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 patient out-of-pocket costs, such as copayments or deductibles. The federal guarantee does not require similar coverage for vasectomy or male condoms. In administering this coverage, health plans may apply formularies, prior authorization requirements and similar restrictions only within a method category (e.g., to encourage patients to choose one hormonal IUD over another) but not across types of methods (e.g., to favor 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. Moreover, 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 a six-months or one-year supply of a method at once (rather than a one- or three-month supply, as is typical) or requiring coverage of male sterilization without out-of-pocket costs.

The federal guarantee permits some religious employers to refuse to provide coverage for some or all contraceptive methods and services. Most of the state laws have similar or broader exemptions in place. In addition, the federal government has established an “accommodation” that allows other nonprofits and closely held for-profit firms with religious objections to opt out of paying for, arranging for or communicating about contraceptive coverage; under that accommodation, the affected employees and dependents must still receive contraceptive coverage from the insurer at no additional cost.

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

Insurer

Arizona

X

 

 

 

 

 

 

Expansive

Employer

Arkansas

X

 

 

 

 

 

 

Broader

 

California

X

X

X

 

X

X

X

Limited

Employer

Colorado

X

 

Ψ

 

 

 

 

 

 

Connecticut

X

 

 

 

 

 

 

Expansive*,†

Insurer

Delaware

X

 

 

 

 

 

 

Expansive

Employer

District of Columbia

 

 

X

 

 

 

 

 

 

Georgia

X

 

 

 

 

 

 

 

 

Hawaii

XӨ

 

X

 

 

 

 

Expansive†

Employer

Illinois

X

X (no male condoms)

X

X

X

X

X

Expansive‡,§

 

Iowa

X

 

 

 

 

 

 

 

 

Maine

X,Ψ

 

Ψ

 

Ψ

Ψ

 

Broader

Employer

Maryland Ω

X

 Ψ

Ψ

Ψ

 

Ψ

 

Expansive

Employer

Massachusetts

X

 Ψ

Ψ 

 

 Ψ

 Ψ

 

Broader

  Ψ

Michigan

X

 

 

 

 

 

 

Broader

 

Missouri

X

 

 

 

 

 

 

Expansive†,‡

Insurer

Montana

X

 

 

 

 

 

 

 

 

Nevada

X

 Ψ (female condoms and EC)

Ψ

 

Ψ

Ψ

Ψ

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 (no condoms) 

X

Ψ

Ψ

Ψ

Ψ

Limited

 

Rhode Island

X

 

 

 

 

 

 

Broader

Employer

TennesseeӨ

 

 

 

 

 

 

 

 

 

Texas**

 

 

 

 

 

 

 

 

 

Vermont

X

 

X

X

X

X

X

 

 

Virginia**

 

 

€ , Ψ

 

 

 

 

 

 

Washington

X

 

Ψ

 

 

 

 

 

 

West Virginia

X

 

 

 

 

 

 

Expansive†

Insurer

Wisconsin

X

 

 

 

 

 

 

 

 

TOTAL

28

2

7

2

3

4

3

20

14

* Religious insurers are not exempt from the mandate but may provide contraceptive coverage through a subcontract with another insurer or third-party entity.
Ψ The following states have enacted laws that will not apply to insurance plans until a later date: Colorado (January 2019), Maine (January 2019), Maryland (January 2018), Massachusetts (August 2018), Nevada (January 2018), Oregon (January 2019), Virginia (January 2018) and Washington (January 2018).
† Enrollees have the option of coverage direction from insurer.
‡ Refusal clause applies to insurers.
§ Refusal clause applies to secular entities that object on moral or religious grounds.
Ω A 2016 law, that goes into effect in January 2018, will require coverage of male sterilization, prohibit cost-sharing, prohibit restrictions and delays, require coverage of over-the-counter methods, and require coverage of an extended supply of a method.
**Employers must be offered the option to include coverage of contraceptives within the health plan.
€ 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 the health plan 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.
ᵝ The state allows pharmacists to prescribe and dispense contraceptives, but insurance coverage of these services is not explicitly included in the law.