Women’s Health

I bought emergency contraception over-the-counter (OTC) at my pharmacy and thought it would be covered by my insurance, but I ended up having to pay the full cost out-of-pocket. Why wasn’t it covered by my insurance?

Emergency contraception is one of the 18 FDA-approved methods for women that is covered by ACA-compliant plans, but it has to be prescribed by a health care provider in order for most insurance plans to cover it. If you don’t have a prescription, you will likely have to pay the full cost out-of-pocket.  However, you can ask your provider for a prescription for OTC emergency contraception, bring it to the pharmacy counter, and ask them to bill your insurance; your insurance should cover it without cost sharing..

If you are covered by a plan that was in effect on or before March 23, 2010, it may be a “grandfathered plan.” These plans are not required to cover preventive services, or they may require cost sharing. If you are not sure if your plan is grandfathered, check with your employer or your insurance plan.

If you are enrolled in an employer-sponsored plan and the employer has a religious or moral objection to contraceptives, your plan may not cover emergency contraception even with a prescription. In addition, short-term health insurance policies do not have to provide benefits required by the ACA and may not cover preventive services. Health care sharing ministries, which are membership groups usually affiliated with a religion that help members pay for health care (not insurance), are also not subject to ACA benefit requirements.

While we have made every effort to provide accurate information in these FAQs, people should contact the health insurance Marketplace or Medicaid agency in their state for guidance on their specific circumstances.

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