Key Points

  • The Guttmacher Institute analyzed data on costs and reimbursement from Title X providers representing more than 350 health centers serving more than 900,000 contraceptive clients.
  • The analysis compared costs and reimbursement for 20 procedure codes commonly used by family planning providers, for three types of payers: Medicaid fee-for-service, Medicaid managed care plans and private insurance plans.
  • For patient visits, the median Medicaid fee-for-service reimbursement was 45–49% of the actual cost of providing that care. Medians for insertion and removal of long-acting reversible contraceptives (IUDs and implants) were somewhat higher, at 49–74%.
  • Reimbursement under Medicaid managed care was typically lower than that under Medicaid fee-for-service. The managed care plans paid a median of 41–46% of actual costs for patient visits and 27–33% of costs for IUD insertion and removal.
  • Private insurance reimbursement was typically slightly higher than Medicaid fee-for-service reimbursement. Private plans paid a median of 55–58% of actual costs for patient visits, and 53–74% of costs for IUD and implant insertion and removal.
  • Many providers’ experiences varied considerably from these medians. Yet, few providers reported being reimbursed in full for any of the 20 procedure codes analyzed, from any payer.