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HHS tells insurers they must cover all contraceptive methods

Payers must cover one version of each of 18 FDA-approved birth control methods

Insurers must provide coverage of all kinds of contraceptive methods for free for their members, the Obama administration announced Monday.

In a new guidance document, the U.S. Department of Health and Human Services (HHS) said insurers must cover at least one version of each of the 18 birth control methods that are approved by the Food and Drug Administration--without any co-pays. Insurers must comply with the new policy within 60 days.

Contraception methods include daily birth control pills, hormonal patches, vaginal ring, intrauterine devices and the morning-after pill. HHS clarified that insurers can choose to cover generic versions of the birth control options unless a doctor believes a more expensive alternative is medically necessary.

The directive comes after reports that insurers weren't complying with the Affordable Care Act's requirement that they pay for contraception for female members. The Kaiser Family Foundation concluded in a report that many insurers violate the ACA's contraception provision, while the National Women's Law Center (NWLC) found in a separate report that 56 plans across 13 states fail to cover all birth control methods, FierceHealthPayer previously reported.

"This has been a problem for women," Cindy Pearson, executive director of the National Women's Health Network, told the Associated Press. "It seems like some insurers were trying to control costs under cover of medical management."

Gretchen Borchelt, vice president for health and reproductive rights at NWLC, told the National Journal that the HHS guidance "makes it absolutely clear they have to cover the method that's right for the women."

In addition to the contraception coverage, HHS specified that insurers must pay for the following:

  • Women's preventive health services, including maternity care for members' dependents.
  • Screening, counseling and genetic testing for women with increased risks for breast cancer because of a gene mutation.
  • Anesthesia services for colonoscopies.
  • Medically appropriate preventative services for transgender people. The agency clarified that, if a provider recommends, for example, a mammogram for a transgender man who has residual breast tissue, insurers must fully pay for that procedure.

To learn more:
- here's the HHS guidance
- read the AP article
- see the National Journal article

Related Articles:
Insurers violate ACA's women's health coverage requirements, reports say
Report: Contraception coverage varies across health plans
Insurers find loopholes around covering contraceptives