WASHINGTON, D.C. – Today the National Women’s Law Center (NWLC) released a new report: Intended vs. Implemented: The Still Unfulfilled Promise of the Affordable Care Act’s Birth Control Benefit. The report reveals a pattern of insurance plans denying coverage, imposing unexpected out-of-pocket costs, and putting administrative barriers in place as women try to access contraceptive care, all in violation of the Affordable Care Act’s (ACA) guarantee of no-cost contraceptive coverage.

The report relies on data from the CoverHer Hotline, a NWLC resource created in 2013 to provide information and assistance to individuals seeking the no-cost women’s preventive health services promised by the ACA. The Hotline provides assistance understanding coverage rights, navigating insurance denials or billing issues, and identifying next steps to obtain the no-cost contraceptive care guaranteed under federal law.

“For over a decade, CoverHer has heard from thousands of people who encounter unlawful denials, unexpected out-of-pocket charges, and administrative barriers when trying to access no-cost contraceptive care,” said Lauren Wallace, NWLC’s senior counsel and CoverHer’s principal intake specialist. “Our report shows that insurance companies continue to skirt the law, and women are the ones left paying the literal and figurative price. The Trump administration should enforce this law, but instead is undermining access to contraception and radically restructuring our nation’s family planning programs. State officials and other stakeholders must take up the charge to ensure people have the contraceptive coverage guaranteed by law.”  

CoverHer data reveals persistent and widespread insurer noncompliance with the ACA’s no-cost contraceptive coverage requirement. Key findings in the report include: 

• Plans are excluding entire categories of contraceptive methods from coverage;
• Plans are denying coverage for services that are integral to contraceptive care, including office visits, ultrasounds, anesthesia for sterilization surgery, and follow-up care;
• Plans are imposing unlawful medical management techniques, including “try and fail” protocols and age limits, and refusing to cover brand-name contraceptives or sterilization surgery;
• Plans are not providing 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.

The report also includes trends on birth control coverage based on CoverHer intake, including the types of birth control that are most likely to get rejected, and how much individuals are paying for out of pocket expenses that should be covered without cost-sharing. For example:

• From 2022 to 2025, the average reported out-of-pocket cost among CoverHer callers resulting from denied coverage was $2,097.19 per year.
• Following the Supreme Court’s decision to overturn Roe v. Wade, intakes from people seeking permanent contraception—specifically bilateral salpingectomy—rose sharply. 

NWLC’s full report can be found here.