The Affordable Care Act (ACA) established an important nationwide standard for insurance coverage of contraceptives. Nearly all private health plans, as well as plans offered through the ACA Healthcare Marketplace and the ACA’s Medicaid expansion, must cover the full range of contraceptives and related services for those who can become pregnant, without cost-sharing. This means no copayments, coinsurance, or deductibles.  

Since 2013, the National Women’s Law Center’s CoverHer Hotline has been a source of information and assistance to individuals seeking no-cost women’s preventive services, including birth control. Over more than a decade of operation, CoverHer has heard from thousands of individuals who—regardless of insurance type, geographic location, or method of contraception—continue to encounter unlawful denials, unexpected out-of-pocket charges, and administrative barriers when trying to access no-cost contraceptive care. These inquiries provide a unique window into how the contraceptive coverage requirement functions in practice and where it breaks down for patients. CoverHer data shows clear and recurring patterns of insurer misconduct, including: 

• Excluding entire categories of contraceptive methods from coverage; 
• Denying coverage for services that are integral to contraceptive care, including office visits, ultrasounds, anesthesia for sterilization surgery, and follow-up care; 
• Imposing unlawful medical management techniques, including “try and fail” protocols and age limits, and refusing to cover brand-name contraceptives or sterilization surgery; 
• Failing to provide a way for individuals to get the particular contraceptive product they need and forcing them to try other processes, like prior authorization or appeals processes that delay care and discourage people from asserting their rights. 

Individuals contact CoverHer after paying hundreds or thousands of dollars for products and services that should be free, spending months contesting improper denials, or forgoing medically necessary care entirely. The full report examines each of these patterns in depth—drawing on first-person accounts shared with the CoverHer Hotline—the harms they cause, and the steps states and other actors can take to ensure people receive the no-cost contraceptive coverage guaranteed by the ACA. 

Find the report here.