Does Medicaid Cover Emergency Contraception


Who Is Covered Under Medicaid Expansion

Emergency Contraceptive Pills (Women & Partners) – Family Planning Series

The Affordable Care Act allows states to expand their Medicaid programs to cover individuals and families with incomes up to 138% of the federal poverty level. With this expansion, many more women are eligible to get their birth control paid for by Medicaid. Go to’s Medicaid expansion information to see if your state has expanded coverage.

Also, some states have chosen a separate option created to provide family planning services and supplies to certain individuals. You can contact your state Medicaid agency to find out if you are eligible for coverage under this option.

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The American Congress of Obstetricians and Gynecologists: “Committee Opinion: Benefits to Women of Medicaid Expansion Through the Affordable Care Act,” January 2013. “Is my state expanding Medicaid coverage?” “Eligibility.” âAdministration takes steps to ensure womenâs continue access to contraception coverage, while respecting religious-based objections.â

Will My Doctor Exam Also Be Free If I Get A Prescription For Birth Control At That Appointment

Often, yes. Your well-woman visits are covered with no out-of-pocket costs to you under the Affordable Care Act. During this visit, your doctor can tell you about the types of birth control available to you and write you a prescription. However, if during the visit the doctor diagnoses or treats you for another medical condition, you will likely have to pay out-of-pocket costs for the visit.

How Do I Decide Which Type Of Birth Control To Use

Among the many factors to consider are:

  • insurance coverage
  • cost, for people with no or incomplete coverage
  • whether the contraception should be long or short term
  • whether it should be reversible or permanent
  • whether it protects against STIs

A healthcare professional can describe the options and make recommendations.

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How Much Does Plan B Cost

Plan B One-Step usually costs about $40-$50. Generics like Take Action, My Way, Option 2, Preventeza, My Choice, Aftera, and EContra generally cost less about $11-$45. You can also order a generic brand called AfterPill online for $20 + $5 shipping.

The brand of EC you buy or how much you pay for it doesnt matter all brand-name and generic levonorgestrel morning-after pills work just as well.

You may be able to get the morning-after pill for free or low cost from a Planned Parenthood health center, your local health department, or another family planning clinic. Call your nearest Planned Parenthood to see if they can help you get emergency contraception that fits your budget.

If you have health insurance or Medicaid, theres a good chance you can get Plan B for free you just have to ask your nurse or doctor for a prescription so your health insurance will cover them . The staff at your local Planned Parenthood health center can also help you figure out if your health insurance will pay for your morning-after pill. Read more about using health insurance to pay for emergency contraception.

Since the morning-after pill works better the sooner you take it, its a good idea to get it BEFORE you need it. You can keep it in your medicine cabinet and it will be there for you, just in case. That way you can take it as soon as possible if an accident happens, and you wont have to worry about finding it at the store when youre stressed out.

What Is Considered An Urgent Medical Condition To Qualify For Emergency Medicaid

What does getting covered add up to?

Emergency medical conditions are those health ailments, disorders and diseases that develop with acute symptoms.

They have noticeable severity, such as intense pain, including those where the absence of urgent medical care may result in the person:

  • Experiencing severe health problem
  • Suffering from impaired bodily functions
  • Suffering from dysfunction of organs or part of their body

However, the definition of emergency medical assistance does not cover organ transplant procedures.

To be eligible to receive emergency Medicaid services, the patient should showcase the sudden onset of the medical disorder.

The patient should showcase the symptoms when the medical treatment is offered. Otherwise, it will not be considered an emergency medical situation and will therefore not be covered by Medicaid.

It is also not necessary that all medically necessary healthcare services come under the definition of emergency medical situation. For instance, debilitating conditions, such as heart problems or other problems that require rehabilitation, are not considered to be emergency medical conditions.

Discontinuation of Medicaid-covered care may result in an emergency medical situation that is not considered in emergency Medicaid.

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Is Plan B Covered By Insurance

If you have insurance or Medicaid, you can often get Plan B for free, though youll have to ask a healthcare professional for a prescription so insurance will cover it.

This may put you in a pinch when time is of the essence, but it can be helpful to plan ahead and keep it on hand should an emergency arise.

How Do Birth Control Pills Prevent Pregnancy

The birth control pill works by stopping sperm from joining with an egg. When sperm joins with an egg its called fertilization.

The hormones in the pill safelystop ovulation. No ovulation means theres no egg for sperm to fertilize, so pregnancy cant happen.

The pills hormones also thicken the mucus on the cervix. This thicker cervical mucus blocks sperm so it cant swim to an egg kind of like a sticky security guard.

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How Much Is Birth Control

It depends on the type of birth control. Contraceptive pills can cost anywhere between zilch to $50 depending on whether you have insurance or youre taking a generic or brand-name option.

Theres also the cost of the appointment. If you have health insurance, the telehealth visit may be covered. Always check with your insurance before assuming anything, though.

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How Is My Income Linked With My Medicaid Copay Amount

How Does the Morning After Pill/Emergency Contraception Work? | Planned Parenthood Video

In this section, weâll provide you with an overview of what you can expect your copay to be depending on where you fall in relation to the FPL.

The Medicaid website was last updated in 2013, so it is quite possible that the payments have changed slightly.

Contact your state Medicaid agency for up to date details

Also, since the rules will vary based on your state, you may want to reach out to your state directly for your specific out-of-pocket expenses regulations. Check out the state by state contact information for Medicaid agencies here.

That being said, letâs take a look at your approximate expenses based on income. Remember, income is classified as your MAGI by the HHS.

Your maximum copayments are capped each quarter, or a 3-month period, like âJan-Feb-Marâ, âApr-May-Junâ, etc.

The maximum costs below are all calculated on a quarterly basis.

If your income is at 100% FPL or below

Inpatient care You maximum copay is $75

Outpatient care $4

Non-emergency use of ER $8

Preferred prescription drugs $4

If your income is between 100-150% FPL

Inpatient care 10% of what your state pays for the service.

Outpatient care 10% of what your state pays for the service.

Non-emergency use of ER $8

Preferred prescription drugs $4

If your income is at above 150% FPL

Inpatient care 20% of what your state pays for the service.

Outpatient care 20% of what your state pays for the service.

Preferred prescription drugs $4

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Does Every Health Insurance Plan Have To Pay For Birth Control

The birth control terms of the Affordable Care Act apply to most health insurance plans, but there are some exceptions:

  • Plans that didnât offer coverage for birth control before ACA and that havenât changed significantly since the law passed in 2010 donât have to add coverage. Check with your plan to find out if this applies to you.
  • Short-term health plans, those that provide insurance for less than 12 months, do not have to provide free birth control.
  • Private employers that object to offering birth control on moral or religious grounds and can get an exemption from the federal government donât have to provide coverage. In some cases, their insurer may still provide birth control benefits without a copay or other charges, but this accommodation is optional. Further court action is expected on this issue.
  • Medicaid programs already offered free birth control prior to the ACA, although they are not required to cover all FDA-approved birth control methods. Check with your Medicaid office to find out what types of birth control are offered. In addition, states are given the option to provide family planning services only for low-income individuals who would not otherwise be eligible for Medicaid. Just over half the states have expanded family planning services under this option.

How To Get Free Birth Control

If you have Medicaid, an employer plan, or an individual or family plan sold after 2010 at least one type of birth control from each of the 18 FDA approved categories is covered for free .

You can get prescriptions for free birth control from:

  • Private and Public Health centers including community health centers, walk in clinics, and Planned Parenthood.
  • A Family Doctor
  • A Hospital specifically in cases where emergency birth control is needed.

Prescriptions can then be filled in the facility or at a local pharmacy. Some birth control, like spermicide, can be sold over the counter and can be purchased at a local pharmacy. Emergency birth control like plan B may be covered without a prescription.

TIP: Make sure to check with your insurer first to understand what birth control is covered under your plan.

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Is Birth Control Free Under The Affordable Care Act

Under ACA, you donât have a copay or other out-of-pocket costs for birth control if you:

  • Get your health insurance through most employers, through your state’s , or from most private insurers, and
  • Have a doctorâs prescription for any type of birth control approved by the FDA this includes the ones usually sold over the counter like spermicides and sponges.

What Is The Family Planning Program

What does getting covered add up to?

This program allows men and women to get family planning services only. This program is a form of limited insurance coverage. If you are able to enroll in the FPP, most of your basic family planning services will be paid for. However, it does not meet the Affordable Care Act requirements for a minimum essential benefits plan.

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How Long Do Emergency Medicaid Benefits Last

Under the Emergency Medicaid statute, eligible patients can receive coverage for treatment lasting for a single day to 15 months. This includes the cost of 3 months retroactive coverage from the date of application and 12 months prospective coverage from the date of application.

The authorization period for this service may begin from the 1st day of the 3rd month to the month of application. This continues up to the last day of the twelfth month.

Insurance Coverage For Contraception In Michigan

  • Insurance Coverage for Contraception in Michigan
  • Ensuring access to reproductive health services, including contraception, is a vitally important part of protecting the health and safety of Michiganders. In addition to being used for family planning purposes or for people for whom pregnancy may pose a medical risk, contraception is also prescribed to control symptoms associated with menstruation and medical conditions such as endometriosis and acne. Recent information from the Centers for Disease Control shows that nearly every woman will use at least one method of contraception at some point in her lifetime.

    Access to Contraceptives

    In 2010, as part of the Affordable Care Act , the federal government created new standards that require nearly all private health plans to cover certain preventive health services with no out-of-pocket cost to consumers. Under this standard most health plans, subject to certain exemptions discussed below, are required to cover, without cost sharing, at least one form of each of the 18 contraceptive methods currently approved by the Food and Drug Administration as prescribed to women by a health care provider. Related health care services, such as an office visit for a contraceptive shot, must also be covered. These requirements generally apply to health plans that are regulated by the federal government or states, including:

    • Individual, small and large group plans
    • Self-insured plans

    Cost of contraceptives

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    New York State Covers Non

    First published online: February 5, 2007

    Although Medicaid normally pays only for prescription medications, as of February 1, Medicaid recipients in New York State may obtain nonprescription Plan B emergency contraception directly from a pharmacy. With Governor Spitzers approval, New York becomes one of the few states to ensure that poor women are able to access this time-sensitive method under Medicaid without first having to visit a physician or clinic. Still, many women in New York and elsewhere do not know what emergency contraception is, when to use it or where to obtain itfacts that point to an ongoing need for public education. Also, women younger than 18 in all states still need a prescription to obtain Plan B, making it more difficult for them to access the method quickly and use it when it is most effective.

    Initiatives such as New Yorks to improve access to emergency contraception are just one way to help low-income women plan their families and prevent unwanted pregnancies: A recent Guttmacher study has shown that expanding Medicaid coverage for contraceptives to match similar coverage for pregnancy-related care would enable low-income women to prevent a total of nearly 500,000 unwanted pregnancies annually, including 200,000 that would end in abortion. By helping women to prevent an estimated 225,000 unwanted births, such an expansion would also save $1.5 billion in annual federal and state expenditures.

    Where Can I Get Services

    The Emergency Contraceptive Pill (Health Workers) – Family Planning Series

    Services are available at any eligible Apple Health provider.

    Condoms and spermicides are available at pharmacies without a prescription.

    Emergency Contraception is available at any eligible Apple Health provider or directly from a pharmacist. For more information, visit the Emergency Contraception website.

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    How Effective Is Plan B One

    A levonorgestrel morning-after pill like Plan B One Step, Take Action, My Way, Option 2, Preventeza, AfterPill, My Choice, Aftera, and EContra can lower your chance of getting pregnant by 75-89% if you take it within three days after unprotected sex.

    You can take Plan B and other levonorgestrel morning-after pills up to five days after unprotected sex. But sooner is better the longer you wait to take it, the less effective it is.

    These types of morning-after pills may not work if you weigh more than 165 pounds. If thats the case, the copper IUD or ella are better options for you. Our handy quiz can help you figure out which EC is best for you.

    Though there are many different brands of levonorgestrel morning-after pills, they all work the same way. All brands have the same amount of medicine and the same effectiveness, no matter how much they cost.

    Does Nys Medicaid Cover Plan B

    NYS Medicaid pays for Plan B for participating residents of the state. Normally, the New York Medicaid program only pays for medications that have been prescribed by a doctor, but since 2007, the program has made an exception for Plan B through qualifying pharmacies. Some beneficiaries in the state of New York have a requirement that has to be paid before Plan B coverage kicks in.

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    How Do I Use Plan B And Other Levonorgestrel Morning

    Take levonorgestrel morning-after pills as soon as you can after unprotected sex. Simply swallow the tablet the way you would any other pill. Read the instructions that come in the package for more information.

    You can take these morning-after pills up to five days after unprotected sex, but they work much better if you take them during the first three days.

    Take a pregnancy test if you havent gotten your period within three weeks after taking the morning-after pill.

    Dont take Plan B One-Step or other levonorgestrel morning-after pills if youve taken ella in the last five days.

    How And Where To Get Free Birth Control

    Turn Over a New Leaf, Consider an IUD

    The logistics depend on the kind of birth control a person wants and whether they have health insurance.

    As we describe above, some types of birth control require a prescription. The cost of the doctors appointment may also be covered if a person has insurance through the Health Insurance Marketplace or an employer that does not have a religious exemption.

    At the appointment, a person discusses their preferred choice with a doctor. The doctor does an examination, asks some questions, and may write the prescription. Some healthcare facilities may be able to provide the birth control right away.

    For people without insurance, the following places may have low-cost birth control options:

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    Will A Marketplace Health Plan Also Cover A Newborn

    Yes. The ACAs EHB requirement mandates coverage of maternity and newborn care. Newborn care covers childbirth and immediate care for the baby after birth. The specifics of this coverage will vary by state and by each individual plan, but all women in Marketplace coverage must also enroll their baby in coverage soon after birth.

    If the newborn is eligible for Marketplace coverage, then the parents can choose to add the baby to the familys existing Marketplace plan or choose a new Marketplace plan for the baby. If they opt for the latter, they can enroll the baby into a new Marketplace plan at any metal tier. However, when enrolling a newborn into Marketplace coverage, other members of the household are generally not permitted to change their existing Marketplace coverage.


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