Women’s Health

I have employer-based coverage and I know my plan is not “grandfathered.” Yet, when I recently filled my prescription for birth control pills, I was charged a co-payment. Aren’t those plans required to cover all contraceptives without cost sharing now?

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Most non-grandfathered plans (plans that started or made changes after March 23, 2010) must cover contraceptives and related services with no cost sharing when they are obtained through an in-network provider. Plans must cover, without cost-sharing,  contraceptive services and FDA-approved, granted, or cleared, prescribed product within each category that an individual and their provider have determined to be medically appropriate for the individual.

If your plan says that the method your provider has recommended for you is not covered without cost-sharing, ask your provider to help you request a “waiver” or “exception” from the insurance company. The “waiver” or “exception” would allow you to use the brand name drug or device with no cost sharing.

However, if your employer has a religious or moral objection to contraceptives, your plan might not include contraceptive coverage.

Browse more questions in the Employer-Sponsored Health Coverage section.

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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