Will Medicaid Pay For Birth Control


What Is The Family Planning Program

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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.

When Is Plan B Prescribed

The most common use of Plan B is as an emergency measure taken after a woman’s regular birth control has failed. This can be for any reason. Plan B is often taken after a condom breaks, after an impulsive and unprotected act of sex or in the emergency room as a preventative measure after a sexual assault. Because Plan B’s effectiveness increases the earlier it is taken, doctors often advise women to buy a dose of Plan B and have it in reserve in case they need it on short notice.

Plan B is widely available over the counter in most states. Adults of both sexes can usually buy a single dose of Plan B directly from the pharmacy counter without any prescription or doctor’s involvement. Girls aged 17 and under generally need to see a doctor to get a prescription before the pharmacy can provide Plan B for them. Boys aged 17 and under generally can’t buy Plan B.

Can I Be Refused Service If I Cant Pay My Medicaid Copay

If your income level falls below 100% FPL, the provider canât refuse you service even if youâre not able to pay your out-of-pocket expense. But you may be billed for your copay at a later date and youâll be held liable for what you owe.

If your income is above 100% FPL, then the provider might have the option to refuse you care if you arenât able to pay your copay, depending on your state. If you fall in this category and you have questions, it is best to contact your state Medicaid administration.

If you fall under one of the exempt groups, the medical services provider who accepts Medicaid can never refuse you service.

For all the details on Medicaidâs âcost-sharingâ rules, check out Medicaid.govâs Overview of Cost Sharing and Premium Requirements.

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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 Can Women Who Work For Religious Institutions Pay For Birth Control

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Not every insurer is required to follow the ACA birth control coverage mandates. Religious institutions, non-profit religious organizations, and religious schools are also exempt from covering birth control. For women whose insurance is through a religious employer, they will have to pay for their birth control out-of-pocket. It is possible though for women to use a third-party insurer to cover the cost of birth control fully.

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Will Insurance Pay For Birth Control

Before the Affordable Care Act , health insurance plans were not required to cover any forms of birth control. After Congress passed the ACA in 2010, insurance companies were required to cover all FDA approved forms of birth control in their plans with no co-pay, no-deductible aka free. 62.8 million women have birth control insurance coverage with no out-of-pocket costs thanks to the ACA. This is 7 million more than in 2015!

US Women now have access to at least 1 in each of 18 categories free contraceptives through their insurance plans. But its important to know which types of birth control are covered under the Affordable Care Act and which contraceptive products are not.

Which Birth Control Products Are Covered Under The Aca

Currently, there are 18 FDA-approved categories of birth control. Under the ACA, insurance companies are required by law to cover at least one contraceptive method from each of these categories.

What are the different types of FDA-approved contraceptive categories?

  • Hormonal birth control methods the pill, patch, ring, or shot.
  • Barrier methods diaphragm, spermicides, female condoms, and sponges.
  • Prescription Emergency Contraception = Ella®
  • Over the Counter Emergency contraceptives such as Plan B® and its generics
  • Implant
  • Intrauterine devices hormonal and nonhormonal IUDs.
  • Sterilization for women
  • Patient counseling and education.

Insurance plans can significantly vary from company to company. Its critical that women understand that a particular insurance company is not required to cover every brand of birth control. An insurer can choose to include a generic birth control pill, instead of a name-brand pill and they would still be operating within the ACA mandates. Insurers can also charge co-pays for name-brand pills. However, if there is no generic form of a particular birth control method and it is necessary for the patient to have it, then the insurer is required to pay for it. The ring is a prime example of this because there is no generic form of the birth control Nuvaring®.

Its also important to note that under the ACA, insurers are not required to cover any abortifacient drugs, or male condoms or vasectomies.

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What Services Are Covered

Family planning and related services cover:

  • Family planning education and risk reduction counseling.
  • All FDA approved birth control methods including: pills, patches, rings, shots, IUDs, implants, diaphragms, cervical caps, condoms, and spermicides , and emergency contraception.
  • Education and supplies for natural family planning and abstinence.
  • Permanent methods: tubal ligations , hysteroscopic sterilization, and vasectomy.
  • Limited screening and treatment for sexually transmitted infections .
  • Screening for cervical cancer and a well woman physical exam.
  • Office visits directly related to a family planning problem when medically necessary.

Family Planning Only does not cover:

  • Vaccinations.
  • Mammograms.
  • Services unrelated to family planning, such as: follow-up of abnormal Pap smears, pregnancy care, evaluation and treatment of health problems like diabetes, asthma, or high blood pressure.

Our Criteria For Choosing The Best Online Birth Control Providers

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You can grab a pack of condoms while buying a Slurpee and a scratch ticket, but other forms of birth control have historically been more annoying to get hold of. Thats because you need a prescription for birth control, so you gotta see a doc to get one.

But with advances in telehealth, its become easier than ever to access healthcare services online, and that includes birth control.

But how can you make an informed decision on which provider to go with? Heres the criteria we used when picking the best of the best:

  • Good reviews. For starters, we looked at reviews of the platform. When it comes to birth control and any other medication, on time delivery is vital and the reviews can help key you into the types of experiences people have had.
  • Available products and guidance. If youre already on birth control, does the provider offer the same product via its platform? If not, is someone available to help you pick another option?
  • Follow up care and support. How much support will you have after getting your new Rx? Is it easy to book a follow-up? Starting birth control or a new type of birth control can cause side effects. You might have questions about your reproductive or sexual health. A quality platform should make it easy to chat with a doc or other healthcare professional about your treatment plan and concerns you may have whether thats through virtual follow-ups or live chats.

The only downside? Its not available in all 50 states. Agh!

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Is Birth Control Covered For Men In Health Insurance Plans

No. Only women’s birth control is covered. Health insurance companies do not have to pay for male birth control, such as condoms and vasectomies. In some states, Medicaid provides family planning services and supplies to eligible men and women under the state plan. Contact your local state Medicaid agency to see if you qualify for coverage for family planning services. In addition, some states require plans to cover vasectomies.

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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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.

Does Medicaid Cover Plan B Emergency Contraceptive

Planned Parenthood
  • Does Medicaid cover Plan B? The Plan B emergency contraceptive pill exists in a complex legal environment. Find out how your Medicaid coverage might pay for it.

Plan B is an emergency contraceptive pill that can prevent a pregnancy in the event of a mishap or lapse with other birth control. A single dose of Plan B, which is available as a low-cost generic, usually costs between $40 and $50. Medicaid benefits sometimes pay for Plan B, as do many other forms of private insurance.

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Is All Contraception Free Under Obamacare

You can expect to pay for some sorts of birth control on almost all plans . Also some plans are exempt from providing any contraceptive coverage as we have discussed.

Some employers and institutions were exempt due to religious objections for a short period of time after a Hobby Lobby lawsuit, however a new rule issued by the Obama administration has provided free contraceptive coverage through a third party so employees still has access to birth control at exempt employers . In a health sharing ministry you can be kicked off the plan for accessing contraceptive services and grandfathered plans and short term plans dont have to cover contraception at all.

Depending on the particular plan, your coverage without cost-sharing may expand to include contraceptive services when using an in-network provider.

Prescription One or more products within the categories approved by the FDA for use as a method of contraception

Over-the-counter Contraceptives available over-the-counter approved by the FDA for women when prescribed by a physician

The morning after pill

Medical devices such as IUD, diaphragm, cervical cap and contraceptive implants

Female sterilization including tubal ligation*

* Certain restrictions may apply you might have to pay a copay, coinsurance or deductible in some cases refer to your plan materials or contact us for more information. Hysterectomies are not considered part of the womens preventive care benefit.

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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How Is My Income Linked With My Medicaid Copay Amount

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

The Cost Of Birth Control By Type

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Start by comparing birth control options. Each one varies in cost, value, effectiveness, and side effects. Both male and female condoms cost $1 or $2, but they can only be used once. Birth control pills can cost as little as $8 per month, but usually cost around $20-$30 every month. Longer-term birth control, such as diaphragms, vaginal rings, IUDs, implants, and hormone shots, can cost from $100 to $1,500.

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Where Can I Get Birth Control Pills

You need a prescription for birth control pills. You can get a prescription from a doctor or nurse at a doctors office, health clinic, or your local Planned Parenthood health center. In a few states, you can even get a prescription online or directly from a pharmacist.

During your visit, a nurse or doctor will talk with you about your medical history, check your blood pressure, and give you whatever exams you may need. Most people dont need pelvic exams in order to get birth control pills. Your nurse or doctor will help you decide whats right for you based on your medical history.

You may be able to get your birth control pills right away during your appointment. Or youll get a prescription from the nurse or doctor, and youll go pick up your pills at a drugstore or pharmacy.

How To Get Birth Control Without Insurance

Lets start with the basics. Even without insurance, anyone with a prescription for birth control can purchase it at a pharmacy.

That means a trip to the doctors office is required. Patients who dont see a doctor regularly can make an appointment at a family planning, public health, or Title X clinic.

For most birth control methods, the doctors visit will be very simple. Very little is required for a doctor to prescribe birth control. The doctor will ask a few questions including the patients medical history and maybe take a few vital signs. Tests arent necessary unless the patient has one or more risk factors, like high blood pressure or a history of smoking.

For more complex birth control methods, such as IUDs, diaphragms, or implants, additional work will need to be performed, such as a pap smear, pelvic exam, or insertion of the birth control device. Additional checkups and a removal procedure might also be necessary. These procedures will cost more.

But how do you actually get birth control? It depends on the method chosen.

Over-the-counter birth control, such as condoms, spermicide, and the morning-after pill simply involve a quick trip to the drugstore. Family planning and STI clinics may provide condoms and spermicide for free. You may be able to simply walk in and request these birth control methods.

The more complex, long-term birth control methods, such as implants and IUDs, must be inserted by a healthcare professional in a medical office.

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How Long Does Medicaid Or Chip Coverage For Pregnancy Last

Medicaid or CHIP coverage based on pregnancy lasts through the postpartum period, ending on the last day of the month in which the 60-day postpartum period ends, regardless of income changes during that time. Once the postpartum period ends, the state must evaluate the womans eligibility for any other Medicaid coverage categories.

7. Is abortion covered by Medicaid or CHIP?

The Hyde Amendment, an annual requirement added by Congress to a federal appropriations bill, prohibits using federal funds abortion coverage except when a pregnancy results from rape or incest, or when continuing the pregnancy endangers the womans life. However, states may use their own funds to cover abortions, and 17 states currently do.


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