The XX Factor

New Report Shows Insurers Are Falling Short on Covering Contraception

The vaginal ring—shown here at an Association of Reproductive Health Professionals convention in California in 2003—reduces user error. So how come some insurance carriers don’t cover it?

Photo by Sandy Huffaker/Getty Images

The U.S. Department of Health and Human Services requires contraception to be covered by your insurance plan without a copay. Yet many women still face serious obstacles getting their contraception of choice covered—and not just those who work for conservative employers. A new report from the Kaiser Family Foundation shows that a lot of insurers are interpreting the coverage mandate in ways that limit women’s access to certain forms of contraception, especially the vaginal ring, emergency contraception, and the IUD. 

“Information was collected from 20 different insurance carriers in five states (California, Georgia, Michigan, New Jersey, and Texas) about how they are applying reasonable medical management (RMM) techniques in their coverage of women’s contraceptive services,” reads the report. RMM is insurance policy–speak for cost management. For instance, your insurance plan may require you to use generics in order to get coverage or, in some cases, refuse a course of treatment entirely if they believe that there’s a more cost-effective way to get the same results. 

Some carriers interpret their right to RMM so aggressively that they are forcing women into contraception methods that may be less effective. For instance, Kaiser found that six of the plans they researched don’t fully cover the Nuva-Ring, which is the only Food and Drug Administration–approved vaginal ring on the market: Five of the six required a copay, and the other didn’t cover it at all. As Emily Crockett at RH Reality Check explains, because the Nuva-Ring and other methods “have the same hormonal formulation as the pill but are more expensive,” insurance providers argue “it’s reasonable to cover the pill but require a co-pay for other methods.” In other words, pushing a woman to switch from the Nuva-Ring to the birth control pill is the equivalent of switching from brand-name pills to generic. The problem with this logic is that methods such as the patch and the ring were developed because the pill is simply less effective for some women.

Kaiser found a similar problem cropping up with emergency contraception. Almost half the carriers in the study didn’t cover Ella emergency contraception, presumably because they did cover some other form of emergency contraception. The problem is that Ella “is a different formulation and has a longer window of effectiveness and it may be preferable for women with a higher body mass index (BMI) than progestin-based EC pills,” the report reads. 

HHS requires that insurers allow women’s doctors to contest the limitations by citing medical necessity, but none of the carriers Kaiser researched had a formal waiver process. 

Insurance companies have a right to put limitations on coverage so long as they meet their obligations to cover medical care for their policyholders. That helps keep costs down for all of us. That said, when it comes to contraception, insurers need to err on the side of more generous coverage. Just because the pill and the ring may look the same on paper doesn’t mean that they work the same way for every woman—and unplanned pregnancy costs a lot more than even the most expensive kinds of contraception