Insurance Coverage for Contraception in Michigan

Ensuring access to reproductive health services, including contraception, is a vitally important part of protecting the health and safety of Michiganders. In addition to being used for family planning purposes or for people for whom pregnancy may pose a medical risk, contraception is also prescribed to control symptoms associated with menstruation and medical conditions such as endometriosis and acne. Recent information from the Centers for Disease Control shows that nearly every woman will use at least one method of contraception at some point in her lifetime.

Access to Contraceptives

In 2010, as part of the Affordable Care Act (ACA), the federal government created new standards that require nearly all private health plans to cover certain preventive health services with no out-of-pocket cost to consumers. Under this standard most health plans, subject to certain exemptions discussed below, are required to cover, without cost sharing, at least one form of each of the contraceptive methods currently approved by the Food and Drug Administration (FDA) as prescribed to women by a health care provider. Related health care services, such as an office visit for a contraceptive shot, must also be covered. These requirements generally apply to health plans that are regulated by the federal government or states, including:

• Individual, small and large group plans
• Self-insured plans
• Federal employee plans

Contraceptives Covered

FDA-approved birth control methods include:

• Barrier methods, like diaphragms and sponges
• Hormonal methods, like birth control pills and vaginal rings
• Long-acting reversible contraception, like intrauterine devices (IUDs)
• Emergency contraception, like Plan B
• Female sterilization procedures
• Patient education and counseling

While some types of the contraceptive treatments listed above are available over the counter, others are available only by prescription. Michiganders are urged to seek the care of licensed medical professionals that work with their health plan, and they should call their health insurer, look at the insurer’s website, or check the insurer’s member handbook to find health professionals that are covered in-network. For health licensing questions, Michiganders should contact the Michigan Department of Licensing and Regulatory Affairs.
For some types of reproductive health treatments, Michiganders may be able to take advantage of telehealth services. For more information about coverage for telehealth, contact your health insurer.

Cost of contraceptives

The federal mandate requires that insurers cover at least one form of each of the FDA-approved contraceptive methods with no out-of-pocket costs, including cost sharing such as coinsurance, or a deductible. If you prefer a type or brand of contraceptive that is not currently covered by your insurer, you may have a copay or other out-of-pocket costs for your treatment.

Grandfathered health plans (generally those sold before the ACA was enacted on March 23, 2010) are not required to provide coverage for contraception under the federal mandate. In addition, your plan or insurer may be exempt from providing coverage for contraception under the federal mandate due to exceptions for religious beliefs and moral convictions. If you have a grandfathered plan or work for an exempted institution or company, you may have to pay out of pocket for your treatments. Contact your health insurer or employer’s benefit office for more information on the coverage that is available to you.

For information about low- or no-cost reproductive health services provided by the State of Michigan, including under the state’s Medicaid program, visit the Michigan Department of Health and Human Services’ Family Planning Program website.

Consumer Assistance:

DIFS can help consumers with health insurance questions and complaints. For more information visit Michigan.gov/HealthInsurance or call DIFS at 877-999-6442, Monday through Friday from 8 a.m. to 5 p.m.