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.
- Federal law requires health insurance coverage for the full range of contraceptive methods used by women, including counseling and related services, without out-of-pocket costs.
- This mandate applies to 18 specific methods delineated by the U.S. Food and Drug Administration (FDA), which includes female sterilization and methods available over the counter (when obtained with a prescription).
- Federal law allows for a “broader” refusal clause that allows churches, associations of churches, religiously affiliated elementary and secondary schools, and, potentially, some religious charities and universities to refuse; hospitals are not allowed to refuse.
- Federal law also requires employees to be notified by their insurers when their health plan does not cover contraceptives.
- 28 states require insurers that cover prescription drugs to provide coverage of FDA-approved prescription contraceptive drugs and devices.
- 3 states require coverage of methods received over the counter; the insurer may still require the enrollee to obtain a prescription.
- 5 states and the District of Columbia require insurers to cover an extended supply of contraceptives at once.
- 2 states require coverage of male sterilization, and 3 states require coverage of female sterilization.
- 3 states prohibit cost sharing for contraceptives.
- 3 states prohibit restrictions and delays, or the use of medical management techniques that restrict access to contraceptives.
- 20 states allow certain employers and insurers to refuse to comply with the mandate; 8 states do not permit refusal by any employers or insurers.
- 3 states include a “limited” refusal clause that allows only churches and church associations to refuse to provide coverage and does not permit hospitals or other entities to do so.
- 7 states include a “broader” refusal clause that allows churches, associations of churches, religiously affiliated elementary and secondary schools, and, potentially, some religious charities and universities to refuse; hospitals are not allowed to refuse.
- 10 states include an “expansive” refusal clause that allows religious organizations, including at least some hospitals, to refuse to provide coverage; 1 of these states also exempts secular organizations with moral or religious objections. (An additional state, Nevada, does not exempt any employers but allows religious insurers to refuse to provide coverage; two other states exempt both insurers and employers.)
- 14 of the 20 states with exemptions require employees to be notified when their health plan does not cover contraceptives.
- United States: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
Monthly State Policy Updates
Get an overview of state legislative and policy activity in all topics of sexual and reproductive health.