No More Co-pay for Birth Control

Aug. 1, 2011 -- Health care reform requires new insurance plans to fully cover women's preventive care, which now will include free birth control, yearly wellness visits, breastfeeding counseling and equipment, and screening for gestational diabetes, domestic abuse, HPV, sexually transmitted infections (STIs), and HIV.

Health and Human Services Secretary Kathleen Sebelius today announced the expanded definition of women's preventive care. The ruling closely follows the advice of an Institute of Medicine expert panel, released July 20.

"Today, as part of the Affordable Care Act, we are announcing historic new guidelines that will help women get the care they need to stay healthy,"  Sebelius said at a news teleconference. "Today we are accepting the recommendations of the Institute of Medicine, so no woman in America needs to choose between paying a grocery bill and paying for the key care that can save her life."

The new requirement does not affect health plans in effect before March 23, 2010. These "grandfathered" health plans include most employer-sponsored plans. However, the majority of employer plans already cover contraception.

Starting August 2012, new health plans will have to offer the expanded wellness coverage without requiring a co-payment. Insurers may "use reasonable medical management to help define the nature of the covered service," according to the Department of Health and Human Services (HHS).

Howard Koh, MD, HHS assistant secretary for health, estimated that by 2013, 34 million U.S. women ages 18 to 64 will receive the benefits spelled out in the new ruling. While preventive care saves money by avoiding or delaying more costly chronic disease care, Koh said the new benefits would mean a "small" increase in premium costs.

The new definition of women's wellness includes access to all FDA approved forms of birth control. The so-called abortion pill RU-486 and similar drugs are not covered.

Religious institutions that offer health insurance to their employees may choose not to offer birth control, according to an amendment to the prevention regulation proposed by the Obama administration. The HHS says it "welcomes comment on this policy."

Preventive services that will be covered without co-pay include:

• Contraception and contraceptive counseling: Women will have access to all FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling.
• Well-woman visits: This would include an annual wellness visit to a doctor. If deemed necessary by her doctor, additional preventive-care visits would also be covered.
• Gestational diabetes screening: This screening is for women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes. Women who have gestational diabetes have an increased risk of developing type 2 diabetes. Their children are at risk for being overweight and insulin resistant.
• HPV DNA testing: Women who are 30 or older will have access to human papillomavirus (HPV) testing every three years, regardless of Pap smear results. Early HPV screening, detection, and treatment reduce a woman's risk of cervical cancer.
• STI counseling, and HIV screening, and counseling: Sexually active women will have access to annual counseling on HIV and sexually transmitted infections (STIs). These sessions have been shown to reduce risky behavior in patients, yet only 28% of women aged 18 to 44 reported that they had discussed STIs with a doctor or nurse.
• Breastfeeding support, supplies, and counseling: Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment.
• Domestic violence screening: During their lifetimes, 25% of U.S. women are the target of intimate partner violence. Early detection and intervention increases an abused woman's safety.

Mammograms and cervical cancer screening already are covered, without co-pay, under the Affordable Care Act. The law also makes preventive services free for women on Medicare.