Our partner, Raising Women’s Voices, shared this great post about new guidance from CMS clarifying what contraception insurance carriers must cover for consumers without any kind of cost sharing. The new guidance also clarifies that preventive care, such as pap smears and mammograms must be covered for transgender consumers needing these services. We’re excited to have clarification on these essential health benefits and are eager to see how they help state advocates and Divisions of Insurance ensure comprehensive coverage for all consumers.
National Women’s Health Week kicked off with an exciting announcement on Monday that the Obama Administration had issued new guidance clarifying that all new health insurance plans have to cover all methods of contraceptive care without charging us anything extra – like a co-pay or deductible.
Raising Women’s Voices and a number of our regional coordinators have flagged problems with contraceptive coverage since last year. Through “secret shopper” surveys and studies of insurance plan formularies, we’ve demonstrated that health plans are refusing to cover more expensive contraceptive methods, such as vaginal rings, and are inappropriately charging women for IUDs and for brand name contraceptives when no generic equivalent exists. These findings were brought to state officials, who asked the U.S. Department of Health and Human Services to clarify what insurers must do to comply with the women’s preventive services amendment to the Affordable Care Act. Two recently-released national studies, from the Kaiser Family Foundation and the National Women’s Law Center, added to the clamor for HHS action.
The Administration finally took corrective action to ensure that women have coverage for the full range of contraceptives and associated services, without additional fees or need for wrangling with their insurers. This week’s announcement is a big step in the right direction, since more than 48 million women in the U.S. will benefit from coverage of preventive services – like contraception – without cost sharing. It’s especially important for low-income women, who cannot afford to pay out of pocket.
Which methods must be covered, and what leeway do insurers still have?
The new guidance, which was issued in the form of a Frequently Asked Questions (FAQ’s) document, clarifies that all new non-grandfathered plans and insurers must cover without cost-sharing at least one form of contraception in each of the 18 methods that the FDA has identified in its current Birth Control Guide. These methods include 1) sterilization surgery for women; 2) surgical sterilization implant for women; 3) implantable rods; 4) IUD copper; 5) IUD with progestin; 6) Shot/injection; 7) combined pill of oral contraceptives; 8) progestin only oral contraceptives; 9) oral contraceptives with extended or continuous use; 10) the patch; 11) vaginal ring; 12) diaphragms; 13) sponges; 14) cervical caps; 15) female condoms; 16) spermicide; 17) emergency contraception (Plan B/Plan B One step/Next Choice); and 18) Emergency Contraception (Ella). The guidance also makes it clear that insurers must cover ancillary services as well – such as patient education and counseling.
Insurers will still be able to use some “medical management” techniques, such as refusing to cover (or charging a co-pay for) a brand-name contraceptive when there is an available generic equivalent that is covered without cost-sharing. So, for example, an insurer may say that it is only covering the Skyla hormonal IUD -- but not the Mirena IUD -- as both are medically-equivalent hormonal IUD methods.
However, the guidance also says that insurers must cover any FDA-approved contraception that a woman’s provider deems medically necessary. Insurers must provide “an accessible, transparent and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider” to ensure that woman is able to quickly appeal for coverage of her preferred method of contraception without cost-sharing.
When do these new rules take effect?
This new clarifying guidance is only enforceable beginning on July 10, 2015. In practical terms, this means that most consumers will not see a change in their policy until their insurance plan starts a new “plan year.” For most women, this will not be until Jan 1, 2016.
Looking ahead, we will continue working with our network of state-based allies to monitor compliance and ensure that that the ACA’s contraceptive coverage mandate is fully enforced. You can count on us to make sure that women get the coverage they deserve, no matter where they live.
NY Attorney General proposes even better contraceptive coverage law
New York Attorney General Eric Schneiderman this week proposed a Comprehensive Contraceptive Coverage Act to address coverage gaps identified in research led by Raising Women’s Voices-NY. The Attorney General’s bill would make it the law in New York that all methods of contraception must be covered without co-pays.
The bill goes beyond the new HHS guidance in several ways, including requiring coverage without co-pays for vasectomies, which are not covered under the ACA Women’s Preventive Services provision. The bill would also allow a woman to obtain a full year’s supply of birth control pills at once, avoiding the need to get refills, and would give pharmacists the ability to dispense emergency contraceptives under a “standing” physician’s prescriptive order, thus allowing for insurance coverage of EC.
The New York bill is modeled on legislation adopted in California last year. Research and initial drafting of the bill was done by staff of Family Planning Advocates of NYS, NARAL NY, the New York Civil Liberties Union and RWV-NY.
HHS also clarifies BRCA testing and transgender care rules
The new guidance from HHS this week also clarifies that all insurers must cover BRCA breast cancer mutation susceptibility gene testing and that those who are having a colonoscopy done as a preventive screening tool for colorectal cancer cannot be denied coverage for anesthesia services.
Finally, the guidance makes another huge step forward in the fight for greater trans-inclusive health care by telling insurers they may not limit sex specific recommended preventive services based on an individual’s sex at birth.
Coco Jervis & Lois Uttley, Raising Women’s Voices