Insurance Coverage for Family Planning Services

To evaluate coverage options for women purchasing insurance through the marketplace in Illinois, EverThrive Illinois and The Section of Family Planning and Contraceptive Research at the University of Chicago conducted a review of contraception and abortion coverage for a selection of health insurance plans available on the marketplace.


This review revealed significant barriers to understanding coverage for both contraception and abortion among QHPs currently available on the Illinois marketplace, including numerous instances in which consumer facing materials were not aligned with internal policies and instances in which information about covered services could not be fully accessed without logging into a member portal. Additionally, this review highlighted considerable need for additional training and resources for customer service representatives, particularly regarding abortion care.


While this review revealed that carriers are offering, and updating, coverage for many contraceptive methods, it also revealed the use of medical management techniques to limit access to certain contraceptive methods. These tactics step therapy, and, most commonly, limiting coverage to generic products. This review found that two of the eight insurance carriers were not compliant with the ACA requirement to provide coverage for the full range of FDA-approved contraception.


In 2015, women represent 54% of individuals enrolled in qualified health plans made available through state and federal marketplaces. Access to effective contraceptive methods can help women to plan their pregnancies, improve birth spacing, and avoid unintended pregnancy—all of which lead to significant health, social, and economic benefits. Knowledge about abortion coverage alongside other reproductive health care services will give women a complete understanding of their benefits. Carriers must comply with the requirements of the ACA and ensure women have easy access to reliable information without judgment.


For more information on coverage for contraception and abortion, of if you are an insured woman who currently pays for birth control, please contact Kathy Waligora




Tuesday, August 11, 2015