Coverage eligibility

The landscape of health care coverage is changing in the United States – and this is good news for women seeking affordable access to contraception, including LARC methods. The Affordable Care Act (ACA) is dramatically expanding the availability of both public and commercial insurance options that are required to cover all methods of contraception approved by the US Food and Drug Administration (FDA), without cost-sharing. The ACA defines cost-sharing as including “deductibles, coinsurance, copayments, or similar charges” [7]. In addition, longstanding Medicaid coverage rules continue to ensure broad access to LARC methods and other family planning services and supplies. However, in spite of these strong requirements, some women continue to encounter barriers to coverage that may be more prevalent in the context of LARC than other less expensive or self-administered methods.

This section provides a basic overview of federal contraceptive coverage requirements for commercial plans, state Medicaid programs, and other types of insurance. Advocacy tips and resources are offered throughout for providers that encounter inappropriate coverage denials in their practices.