Contraceptives provide many health, social and economic benefits. In addition, they are crucial for helping people exercise reproductive autonomy—which is the power to make decisions and control matters associated with contraceptive use, pregnancy and childbearing.
Since the mid-1990s, states have required health insurance plans regulated by the state that provide coverage of prescription drugs and devices to also cover prescription contraceptives. Under a provision of the Affordable Care Act, federal law 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, i.e., use their own funds to cover employees’ claims.
- State and federal insurance laws interact in complex ways. For example, federal law can regulate self-insured plans, which cover about 65% of insured workers who have employer-sponsored health insurance nationwide. The federal guarantee ensures that the coverage requirements apply to individuals covered by these plans. State laws cannot regulate self-insured employers, but apply to other types of health plans that operate within a particular state.
- Under the federal guarantee and additional guidance, insurers and plans must cover all FDA-approved contraceptives that are deemed medically appropriate by the individual’s provider. They must do so, without charging a copayment or coinsurance, when the contraceptive is provided by an in-network provider, regardless of whether the contraceptive is listed in the FDA’s Birth Control Guide. The types of methods that state law requires to be covered vary and are detailed in the chart below.
- The federal guarantee also requires coverage of emergency contraception without cost sharing when it is prescribed by an individual’s health care provider, even though most emergency contraception does not require a prescription. Some states require coverage of emergency contraception without cost sharing, even without a prescription.
- In addition, federal guidance does not require coverage of an extended supply of contraceptives (although guidance has encouraged it). Some states require coverage of an extended supply.
Insurance coverage of contraceptives has been the subject of legal and policy developments related to religious refusals. In its 2014 Burwell v. Hobby Lobby Stores decision, the US Supreme Court ruled that closely held, for-profit corporations, those with a small number of private shareholders, could refuse to provide contraceptive coverage for “sincerely held” religious reasons.
The concept of religious exemptions was further developed through later Supreme Court decisions, as well as through regulations issued by the Trump administration, although the Biden administration rescinded many of these regulations. Many state laws that expand contraceptive coverage contain explicit exemptions in their laws related to insurance coverage of contraception, while other states have more general state-level religious exemptions.
Visit our state legislation tracker for more information on state-level contraception policies.