Under the Affordable Care Act, insurers must cover Food and Drug Administration (FDA)-approved prescription birth control as a free preventive service.
State law also requires this and the following benefits:
- Free coverage for all FDA-approved, over-the-counter birth control, including condoms, spermicides, emergency birth control and sponges.
- Coverage for birth control on your plan's drug list (also called a formulary) if it uses one for other covered prescriptions.
- Outpatient coverage for all medical services related to giving prescription birth control.
- Free coverage for voluntary sterilization and vasectomies.
- Accommodations for birth control if you get coverage from certain religious employers.
- Coverage for abortion services if your health plan covers maternity services.
- Coverage for abortion services if you joined or renewed a student health plan that provides maternity care after Jan. 1, 2022.
No cost to you for birth control
Health plans can't require copays or deductibles for prescription birth control you get from a pharmacy or provider on your plan. However, if you have a Health Savings Account (HSA), your plan may require a deductible for over-the-counter birth control. It can't be more than the minimum deductible for an HSA plan.
Individual/family and certain group health plans in Washington state must cover a 12-month refill of birth control pills rather than 12 separate 30-day refills. You don't need to pay for these prescriptions. That means you'll get a 12-month supply of birth control pills in one visit to the pharmacy without paying. However, you can ask for a smaller supply. Your doctor can also prescribe a smaller amount if needed.
Know your rights
Your health plan can't:
- Require prescriptions for FDA-approved, over-the-counter birth control.
- Charge copayments or coinsurance for FDA-approved birth control.
- Limit you to certain birth control, such as generics, without letting you ask for an exception if your provider approves your preferred birth control.
- Deny coverage of birth control because you changed birth control methods within a 12-month period.
- Have unnecessary requirements, limits or delays before you can get coverage for birth control.
- Limit coverage or benefits based on your gender.
- Limit your choice in accessing all FDA-approved birth control.
If you believe your health plan wrongly denied your coverage, file a complaint and we'll investigate.
See additional health benefits for women.
If you have a grandfathered plan
Changes to health care laws don't cover grandfathered plans. If you have a grandfathered plan, you may need to pay copayments, deductibles and coinsurance for prescription birth control.