Regardless of personal opinions or political affiliation, the Affordable Care Act (ACA), also known as the ObamaCare, is something that surely has a significant impact on the lives of Americans and their families. Since its inception, it has been surrounded by many controversial issues. One of the hottest subjects related to the health care reform is its requirement to cover contraception, which is relevant to women of child-bearing age. Now, it is very important to educate ourselves about how this will change our coverage at present and in the future. Here are some basic facts about the ObamaCare and contraception.
Types of Contraception the ACA Covers
According to healthcare.gov, virtually all conventional methods of contraception are covered by the ObamaCare, which means that you do not have to stop using preferred method for another just to qualify for coverage. As the website states, all methods of contraception that are prescribed by doctors and approved by the Food and Drug Administration (FDA) are covered. These include the barrier methods, hormonal methods, implanted devices, emergency contraception, sterilization procedures for women, patient education and counseling. Those that are not covered are abortion-inducing drugs and services that are related to the male reproductive capacity, such as vasectomy.
What Does One Has to Pay
Under the health care reform, FDA-approved contraception methods are fully covered by most health insurance policies without any additional out-of-pocket cost, which means there is no co-insurance, co-pay or deductible. But while the law does not allow insurers to determine which contraception methods they will cover, it gives them the freedom to choose which brands they will cover fully. So, if you go for a brand-name pill, instead of a generic version (which you can get for free), your employer can charge a co-pay. However, if your doctor says that it is not safe for you to take the generic version, the co-pay will be waived. Also, if you have an HMO, POS or PPO plan for insurance, any service you use to obtain your contraceptives should be conducted by an in-network provider for it to be covered, otherwise you might have to a portion of the cost.
Of course, there are exceptions. Grandfathered plans, which are those already in effect before the ObamaCare was enacted, do not have to follow all the law’s guidelines, as long as they are not making any significant changes, such as drastic increases in coinsurance, co-payments or deductibles and cuts in benefits, which can make them lose their grandfather status. Other health policies that are exempt from contraception coverage include plans at churches and religious organizations as well as self-funded student health plans. Much controversy is circling around which groups would qualify for religious exemptions, where some lawsuits were filed to the Supreme Court, opening up the possibility of the ACA details to be modified to find compromise between the concerns of some employers who prefer to refuse offering contraception coverage and the goal of making contraception more widely accessible.
Issue on the Inclusion of Condoms
As of the moment, the ObamaCare does not apply to male contraception methods, which include condoms. However, for women, over-the-counter (OTC) contraceptives like female condoms and spermicides are covered as long as they are approved by the FDA. It is stressed by the law, though, that these OTC products must be prescribed by doctors, making it quite more difficult to obtain coverage. Moreover, while some “morning-after pills” (as what many people call them) are approved by the FDA and covered by the plan under the ACA, drugs and methods for abortion are not.
Issues in Getting Contraception Covered Under the ObamaCare
Naturally, snags can occur with the ObamaCare, considering that it is not only a new program, but also huge. A Guttmacher Institute survey found out that some private health plans are inadequately following the ACA, and despite the mandate that all methods of female contraception approved by the FDA are covered, some insurance companies are still not offering full coverage for certain methods, such as IUDs, patches and contraceptive rings. For instance, women who are choosing to use a hormonal patch are paying a co-pay, while they can obtain hormonal contraception pills with no out-of-pocket cost. Insurers postulate that because patches use similar ingredients as pills, they essentially have the same function, but the FDA maintains that they have different delivery, so both deserve to be covered.
If you think that you have been charged for contraception that you think should be fully covered under the ObamaCare, you should contact your insurer for clarification of your benefits. As advised by the National Women’s Law Center (NWLC), women who believe they have been denied of the coverage they are entitled to have should speak with their insurance companies as soon as possible. If this does not solve the issue, then NWLC urges these women to file an appeal.
Revised Obamacare Contraception Rule
In July this year, the Obama administration had announced changes to the ACA to make it easier for religious organizations to exempt themselves from covering contraceptive methods for women. Under the ObamaCare rules, most forms of contraception for employees should be covered without any out-of-pocket cost—a provision that has since been under fire from religious groups that are against birth control or those who regard products like “morning-after” pills to be abortifacients, which pertain to substances that induce abortion. And while the contraception mandate of the ACA does not apply to houses of worship, religious groups still pushed for the same protection to be granted to organization that are also affiliated to religion, such as non-profits, schools and hospitals.
Now, under the changes to the ObamaCare, qualified groups having a religious objection to the contraception mandate can send the Department of Health and Human Services a note, rather than alerting the insurance company. It is then the government’s job to notify the insurance company, so it can come up with alternative forms of coverage for contraception. Furthermore, this also applies to privately held companies, of which at least 50 percent is owned by 5 or fewer individuals.